Columbia  Unt  bmittp 

Otollwj*  of  iPbjatriattB  anh  &Krg?att0 


fRrfmttr?  Ktbrarg 


PRACTICAL 

HYDROTHERAPY 

A    MANUAL 

For   Students   and    Practitioners 


CURRAN    POPE,  M.D. 

Professor   of   Physio-Therapy,    University   of  Louisville   Medical  Department ;   Ex-Professor   of 
Physio-Therapy    in     the    Kentucky    School    of    Medicine,    Louisville,    Ky.;    State    Secretary 
American    Physio-Therapeutic   Association;   President   American   Physio-Therapeutic   Asso- 
ciation;  Ex-President   Louisville    Seurological  Society;   President   Ohio    Valley    Medical 
Association;   Consulting   Neurologist   to   the   Louisville   City   Hospital;  Formerly  Resi- 
dent Physician   to   the   Lakeland   Hospital  for  the  Insane;  Ex-Professor  of  Diseases 
of   the   Mind   and    Nervous   System,    Electro-Therapy,   Hydrotherapy,    etc.,    in    the 
Louisville  Medical  College:  Ex-Professor  of  Pathology,  Histology  and  Bacteri- 
ology,   Hospital    College    of    Medicine;    Member    American    Medical    Associa- 
tion;  American    Electro-Therapeutic   Association  ;   American    Roentgen    Ray 
Association :    Mississippi     Valley    Medical    Association;    Kentucky    State 
Medical    Association ;    Jefferson     County     Medical    Society;    Louisville 
Academy     of    Medicine;    American     Medical     Editors'     Association; 
President   Louisville   Society   of  Medicine  and   Surgery;  Ex-Presi- 
dent   Louisville    Medical    and    Surgical   Society;    Member   Inter- 
national  Physio-Therapeutic    Congress.    Rome,    Italy;    Member 
Society  for  the  Advancement   of  Science:  Associate  Editor 
Journal     of     Advanced     Therapeutics ;     Associate     Editor 
Central     States      Medical     Monitor;     Associate     Editor 
Kentucky     Medical     Journal,     and     Medical     Super- 
intendent of  the  Pope  Sanatorium.   Louisville,  Ky. 


CINCINNATI 

CINCINNATI  MEDICAL  BOOK  COMPANY 
1909 


Copyrighted,  1909,  by 
Curran   Pope,  Louisville,   Kv. 


The   Lancet-Clinic   Publishing    Co., 
Cincinnati,  O. 


THIS   BOOK    IS   DEDICATED 
TO  THE    MEMORY  OF 

MY    FATHER    AND    MOTHER 

AS  A  SLIGHT  TOKEN  OF  THE 

DEEP  LOVE  AND  RESPECT  OF  THEIR  SON 

THE    AUTHOR 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/practicalhydrothOOpope 


PREFACE. 

The  author  offers  no  apology  for  another  work  upon  hydrotherapy, 
as  there  are  at  present  very  few  works  in  the  English  language. 

It  cannot  be  denied  that  much  prejudice  has  heretofore  existed 
against  "baths"  owing  to  their  purely  empirical  application,  but  with 
the  advent  of  instruments  of  precision  and  the  establishment  of  their 
physiological  action,  scientific  hydrotherapy  has  taken  its  place  among 
the  accepted  therapeutic  methods  of  medicine. 

It  has  seemed  strange  at  times  why  the  brilliant  clinicians  of  this 
country  have  failed  to  use  hydrotherapy  as  a  curative  agent,  but  of  late 
years  this  cannot  be  said  save  in  certain  quarters,  for  the  profession  is 
rapidly  awakening  to  the  broad  field  of  usefulness  possessed  by  this 
agent. 

The  plan  adopted  has  been  to  ascertain  all  the  facts  possible,  no 
matter  from  what  source,  the  writer's  experience  then  added,  and  from 
the  data  thus  obtained,  the  different  chapters  have  been  written.  The 
aim  has  been  to  simplify  hydrotherapy  and  to  so  plainly  and  clearly 
lay  before  the  reader  the  essential  facts  as  to  render  them  easy  of 
mastery,  accessible  and  useful. 

The  hydriatist's  art  has  not  been  magnified  nor  has  the  author  in- 
dulged in  a  minute  and  endless  subdivision  of  baths,  both  general  and 
local,  each  with  their  physiological  and  therapeutic  action  separate,  but 
has  as  far  as  is  possible  grouped  together  those  procedures  whose  tech- 
nique, physiological  action  and  therapy  closely  resemble  one  another, 
thus  enabling  the  student  to  master  the  action  of  "groups''  rather  than 
each  separate  form. 

To  the  student  or  practitioner  who  may  desire  to  systematically 
acquire  a  knowledge  of  hydrotherapy,  due  warning  is  given  that  there 
is  no  royal  road  to  knowledge,  and  that  this  is  true  of  hydrotherapy  as 
well  as  of  all  the  other  departments  of  science.  However,  a  certain 
line  of  procedure  may  aid  in  more  easily  mastering  the  art.  It  would 
not  be  amiss  to  cursorily  refresh  his  general  knowledge  of  the  anatomy 
of  the  nervous  system,  of  the  blood  and  lymph  circulations.  He  should 
then  carefully  ground  himself  in  the  physiological  action  of  water 
and  its  associated  applications,  such  as  hot  air,  electric  light  baths,  etc. 
A  mastery  of  the  general  principles  of  hydrotherapy,  its  rules  and 
regulations,  will  make  the  technique  more  easy  of  comprehension  and 
its  rationale  apparent. 

Much  information  and  a  clearer  insight  than  mere  description  can 
give,  is  to  note  the  physiological  action  of  hydrotherapy  by  "putting 
yourself  in  his  place."     One  application  of  a  cold  jet  douche  to  the 


vi  PREFACE.    ■ 

spine  gives  more  realistic  information  than  pages  of  description.  I 
therefore  make  the  suggestion  to  "practice  on  yourself"  first.  Many 
experiments  herein  mentioned  have  had  the  author  as  principal  party 
in  interest. 

It  should  never  be  forgotten  that  physiological  forces  so  powerful 
for  good  may  equally  work  havoc  if  carelessly  and  improperly  applied. 
Therefore  utility  and  exactitude  of  method  have  been  the  constant  aim. 

In  the  therapeutic  section  rare  diseases  have  not  been  considered 
unless  water  possesses  some  curative  value  in  that  particular  disease. 
Theories  have  been  avoided  as  they  generally  prove  a  burden  and  in- 
terfere with  a  clear  comprehension  of  the  agent.  Physicians  nor  rem- 
edies possess  healing  powers,  but  the  curative  process,  as  is  well 
known,  resides  within  the  body,  and  it  is  the  body  that  heals  itself.  I 
believe  that  water  is  an  agent  more  capable  of  developing  natural  heal- 
ing powers  in  the  system  and  in  resisting  the  onset,  development  and 
extension  of  disease,  than  any  other  known  single  measure. 

Some  will  doubtless  think  that  the  chapters  dealing  with  nervous 
and  mental  diseases,  drug  habits  and  alcoholism  have  been  needlessly 
enlarged.  The  nihilism  of  therapeutics  that  pervades  these  branches, 
the  neglect  of  a  remedial  measure  so  powerful  for  betterment  and 
"cure/'  has  led  to  a  broad  and  full  consideration  of  these  subjects,  with 
the  hope  that  specialists  in  these  various  fields  of  the  therapeutic  art 
may  be  induced  to  use  this  remedy  more  extensively  than  is  the  case 
at  present. 

A  careful  perusal  will  show  that  hydrotherapy  offers  an  extensive 
and  useful  field  to  the  practitioner  in  acute  and  subacute  conditions, 
for  there  are  many  cases,  especially  of  acute  diseases,  that  could  be 
treated  at  home  by  the  family  physician  with  success,  and  it  is  be- 
lieved that  a  careful  study  of  the  possibilities  of  hydrotherapy  will 
convince  many  medical  men  who  do  not  now  use  hydriatics,  that  it  is 
a  valuable  addition  and  supplement  to  their  other  efforts.  Chronic 
cases  are  best  treated  in  sanatoria  because  of  the  facilities,  the  experi- 
ence, skill  and  knowledge  required  by  the  physician  in  charge,  assisted 
by  a  well-trained  staff. 

Twenty  years  as  teacher  of  students  and  nurses,  twenty  years  at  the 
head  of  a  sanatorium,  in  active  hospital  and  private  practice,  has  con- 
stituted an  experience  upon  which  the  author  has  freely  drawn. 

Thanks  are  due  to  the  publishers  for  their  uniform  courtesy,  kind 
consideration  and  willingness  to  make  this  book  represent  the  author's 
views. 

The  Author. 

Louisville,  Ky.,  September,  1909. 


CONTENTS. 

CHAPTER  1. 

HISTORY   OF   HYDROTHERAPY. 

Of  Great  Antiquity — Used  by  Ancient  Hindoos,  Persians,  Egyptians,  etc. 
— Hydrotherapy  in  Greece — Its  Use  by  Hippocrates — the  Japanese — 
Use  in  Early  Days  of  Roman  Empire — Thermae  of  Rome  and  Pompeii 
— The  Baths  of  Caracalla — Galen — Ambroise  Pare — James  Currie — 
Early  Use  in  Various  Diseases — Vincent  Priessnitz — His  History — 
Early  Impression  and  Use  of  Hydrotherapy — His  Organization  and 
matic  Treatment.  Local  and  General — Fleury's  \^i sit  to  Priessnitz 
— His  Later  Adoption  of  Hydrotherapy  and  Origination  of  the  Douche 
— Brand  and  His  Baths  in  Typhoid — John  Chapman  and  His  Spinal 
Ice  Bag — The  Birth  of  Scientific  Hydrotherapy — Win.  Winternitz  and 
His  Scientific  Work  and  Discoveries — The  Basis  of  Modern  Hydro- 
therapy— Simon   Baruch  and  J.   H.  Kellogg"s  Work 1-10 

CHAPTER  II. 

GENERAL   CONSIDERATION":    ANATOMY   AND    PHYSIOLOGY   OF 

THE  SKIX. 

Definition — Physical  Properties  of  Water — Thermic  Action — Mechanical 
Effects — Adaptability — Cleansing,  Antiseptic  Action — Anatomy  of  the 
Skin — Physiology   of   the    Skin 1 1  -2i  i 

CHAPTER  III. 

PHYSIOLOGICAL  ACTION  OF  WATER  EXTERNALLY  APPLIED. 

Classification  of  Temperatures — Physiological  Action  of  Water  on  Tempera- 
ture— Of  Heat  on  Temperature — Of  Cold  on  Temperature — Physio- 
logical Action  Upon  the  Circulation — Action  of  Heat  Upon  the  Circula- 
tion— Of  Cold  Upon  the  Circulation — Physiological  Action  Upon  Res- 
piration— Action  of  Heat  Upon  Respiration — Of  Cold  Upon  Respira- 
tion— Physiological  Action  Upon  Metabolism — Means  by  Which  it  is 
Influenced — Effect  Upon  Secretion — Upon  Absorption — Upon  Tissue 
Change — Upon  Excretion — Physiological  Action  Upon  the  Nervous  Sys- 
tem— Action  of  Heat  Upon  the  Nervous  System — Action  of  Cold  Upon 
the  Nervous  System — Physiological  Action  Upon  the  Muscular  System 
— The  Action  of  Heat  Upon  the  Muscular  System — Of  Cold  Upon  the 
Muscular  System — Physiological  Action  Upon  the  Blood — The  Action 
of  Heat  Upon  the  Blood — Of  Cold  Upon  the  Blood — Hydrotherapeutic 
Reaction  of  Heat — Of  Cold — Contraindications 21-53 

CHAPTER  IV. 

THE  INTERNAL  USES  OF  WATER. 

The  Supposed  Mystical  Power  of  Springs  and  Spas — The  Necessity  of 
Water — Need  of  Careful  Prescribing — Benefits  from  Water  Itself — 
Rarely    from    Mineral    Contents — Action    on    the    Body — Physiological 

Action   of  Water — Therapeutics 54-61 

vii 


viii  COX  TEXTS. 

CHAPTER  V. 
ASSOCIATED  PROCEDURES. 

Sun  Light — Physiological  Action  of  Light — Therapeutic  Application — In- 
candescent Electric  Light  Bath — Physiological  Action — The  Arc  Light 
Bath — Technique — Therapeutic  Application — Hot  Air  Cabinet — Turkish 
Bath — Vapor  Cabinet — Russian  Bath — Superheated  Dry  Hot  Air — Phy- 
siological  Action   of   Heat  by   Conduction — Therapeutics 64-84 

CHAPTER  VI. 
MINOR  HYDROTHERAPEUTIC  METHODS. 

Local  Heat  and  Cold — Chapman's  Methods ;  Hot  Water  and  Ice  Bags — Fric- 
tion—Sand Bath— Salt  Rub— Oil  Rub— Electric  Bath— Steam 85-94 

CHAPTER  VII. 

RULES,  REGULATIONS  AND  PRACTICAL  SUGGESTIONS 95-106 

CHAPTER  VIII. 

EQUIPMENT  OF  HYDROTHERAPEUTIC  INSTITUTIONS  AND 
SANATORIA     107-113 

CHAPTER  IX. 

THE  TECHNIQUE  OF  HYDROTHERAPY. 

The  Author's  Clinical  Division  of  Baths — Sponge  or  Towel  Bath ;  Ablution 
— The  Dripping  Sheet  or  Sheet  Bath — The  Fomentation — Compresses 
— Cold  and  Cooling,  Their  Therapeutics — Stimulating  Compress — Phy- 
siological Action — Therapeutics — Hot  Compress — Physiological  Action — 
Therapeutics — The  Cephalic  Compress — The  Throat  Compress — The 
Chest  Compress — The  Trunk  Compress — The  Joint  Compress — The 
Wet  Pack — Its  Physiologic  Action — Therapeutics — The  Half  Wet  Pack 
The  Hot  Blanket  Pack— The  Dry  Full  Pack— Local  Baths— Hot  Foot 
Bath— Cold  Foot  Bath— Sitz  Baths— The  Cold  Sitz  Bath— The  Hot  Sitz 
Bath— The  Half  Bath    114-149 

CHAPTER  N. 

THE  TECHNIQUE  OF   HYDROTHERAPY    (Continued). 

The  Very  Hot  and  Hot  Full  Bath— The  Warm  Full  Bath— The  Cleansing 
Bath — Bathing  of  the  Infant — The  Neutral  Bath — The  Continuous  Bath 
— Nauheim  or  Effervescent  Bath — The  Cold  Full  Bath — The  Cold 
Sponge  Bath — Surf  Bathing — Mineral  Baths — Douches — Affusions — 
Shower  Bath — Circular,  Horizontal  Rain,  Needle  or  Spray  Bath — Jet 
Douche — Fan  Douche — Perineal  Douche — the  Scottish  or  Alternate 
Douche — Physiological  Action  of  Hot  Douches — Therapeutics— Physi- 
ological Action  of  Cold  Douches — Therapeutics Io0-193 

CHAPTER  XI. 

SPECIAL   THERAPEUTICS:    FEVERS. 

Simple  Fevers — Typhoid  Fever — La  Grippe:  Influenza — Malarial  Fevers — 
Measles — Chicken  Pox — Whooping  Cough — Scarlet  Fever — Diphtheria — 
Mumps — Erysipelas — Cerebro-Spinal  Meningitis — Smallpox — Yellow  Fe- 
ver— Cholera — Cholera  Nostras — Typhus  Fever — Montana  Spotted 
Fever    194-232 


CONTENTS.  ix 

CHAPTER  XII. 

DISEASES  OE  THE  STOMACH  AND  INTESTINAL  TRACT. 

Acute  Gastritis — Chronic  Gastritis — Gastric  Atony;  Dilatation — Intestinal 
Atony — Splanchnoptosis — States  of  Hypersecretion  :  Hyperchlorhydria, 
Hyperchylia.  Reichmann's  Disease,  Chronic  Sthenic  Gastritis — Gastric 
Ulcers — Duodenal  Ulcers — States  of  Hyposecretion  :  Hypochlohydria, 
Achlohydria,  Anacidity,  Hypochylia,  Achylia  Gastrica,  Hypopepsia, 
Apepsia — Acute  Intestinal  Catarrh — Acute  Enteritis — Acute  Entero-Co- 
litis — Acute  Gastro-Entero-Colitis  of  Children — Cholera  Infantum — 
Summer  Diarrhea — Summer  Complaint — Acute  Diarrhea — Acute  Dys- 
entery— "Bloody  Flux" — Acute  Colitis — Acute  Proctitis — Chronic  En- 
teritis— Chronic  Entero-Colitis — Chronic  Intestinal  Catarrh — Chronic 
Diarrhea — Chronic  Dysentery — Chronic  Colitis — Chronic  Proctitis — 
Constipation — Neuroses  of  the  Stomach  and  Intestines — Gastralgia — 
Gastric  Hyperesthesia — Derangements  of  Appetite — Anorexia — Hyper- 
koria — Boulimia — Akoria — Polyphagia — Parorexia — The  Motor  Neuro- 
ses —  Gastrospasm  —  Cardiospasm — Pylorospasm — Hyperistalsis — Ner- 
vous Vomiting — Rumination  —  Mercyism  —  Regurgitation — Enteralgia — 
Intestinal  Colic — Meteorism — Tympanites — Peristaltic  Unrest 233-252 

CHAPTER  XIII. 

DISEASES  OF  THE  NASOPHARYNX,  LARYNX  AND  CHEST. 

Acute  Rhinitis — Acute  Pharyngitis — Acute  Tonsillitis — Acute  Laryngitis  and 
the  Treatment  of  Post-Operative  Inflammations — Chronic  Rhinitis — 
Chronic  Pharyngitis — "Clergyman's  Sore  Throat" — Chronic  Tonsillitis 
— Chronic  Laryngitis — Croupous  Laryngitis — Spasmodic  Laryngitis — Lar- 
ingismus  Stridulus — Acute  Bronchitis — Capillary  Bronchitis — Chronic 
Bronchitis — Fibrinous  Bronchitis — Pulmonary  Congestion — Pulmonary 
Edema — Hemoptysis — Pulmonary  Hemorrhage — Lobar  Pneumonia — Ca- 
tarrhal Pneumonia — Asthma — Hay  Fever — Hay  Asthma — Emphysema — 
Tuberculosis — Prophylaxis — Prevention  of  Acute  and  Chronic  Respira- 
tory   Inflammations — Pleuritis 253-279 

CHAPTER  XIV. 

DISEASES  OF  THE  PERITONEUM;   LIVER;   RHEUMATISM;   GOUT; 
DIABETES;  OBESITY;  RACHITIS. 

Peritonitis — Ascites — Dropsy — Anasarca  —  Hepatic  Congestion  —  Catarrhal 
Jaundice — Cholelithiasis — Acute  Infectious  Cholecystitis — Cholangitis — 
Hepatic  Cirrhosis — Acute  Articular  Rheumatism — Chronic  Articular 
Rheumatism — Muscular  Rheumatism — Rheumatoid  Arthritis — Gout — 
Lithemia — Uric  Acid  Diathesis — Diabetes  Mellitus — Diabetes  Insipidus — 
Obesity  —  Rachitis 280-305 

CHAPTER  XV. 

DISEASES  OF  THE  KIDNEY  AND  BLOOD. 

Renal  Hyperemia — Acute  Nephritis — Chronic  Nephritis — Chronic  Parenchy- 
matous and  Chronic  Interstitial  Nephritis — Uremia — Nephroptosis — 
Floating  Kidney — Renal  Colic — Anemia — Chlorosis — Pernicious  Anemia 
— Splenic   Anemia — Leukocythemia — Hodgkins'    Disease 306-315 


x  COX  TEXTS. 

CHAPTER  XVI. 
DISEASES  OF  THE  HEART  AXD  BLOOD-VESSELS. 

Pericarditis — Endocarditis — Myocarditis — The  Treatment  of  Chronic  Or- 
ganic Disease  of  the  Heart  and  Blood-vessels — Schott  Resistive  Gym- 
nastics— Oertel's  system — Chronic  Cardiac  Disease :  Organic  Valvular 
Heart  Disease,  Mitral  Regurgitation,  Aortic  Regurgitation,  Tricuspid 
Regurgitation,  Pulmonic  Regurgitation,  Mitral  Stenosis,  Aortic  Stenosis, 
Tricuspid  Stenosis,  Pulmonic  Stenosis,  Chronic  Myocarditis — Cardiac 
Dilatation — Cardiac  Hypertrophy — Fatty  Heart — Arterio-Sclerosis  :  Hy- 
pertension— Angina  Pectoris — Functional  Heart  Disease  :  Cardiac  Neu- 
roses, Cardiac  Collapse,  Neurasthenic  or  Weak  Heart,  Palpitation, 
Brachycardia,  Tachycardia,  Arhythmia    316-335 

CHAPTER  XVII. 

DISEASES  OF  THE  PERIPHERAL  NERVES,  BRAIN   AND 
SPINAL  CORD. 

Neuritis — Facial  Palsy — Sciatic  X'euritis — Sciatica — Multiple  Neuritis — Neu- 
ralgia— Intercostal  Neuralgia — Tic  Douloureux — Meningitis — Cerebral 
Pachymeningitis  —  Acute  Leptomeningitis  —  Tubercular  Meningitis — 
Spinal  Pachymeningitis — Spinal  Meningitis — Cerebral  Hemorrhage — 
Cerebral  Apoplexy — Cerebral  Thrombosis — Cerebral  Embolism — Acute 
Myelitis — Acute  Poliomyelitis — Polioencephalitis  Superior — Landry's  Par- 
alysis— Acute  Bulbar  Paralysis — The  Caisson  Disease — Chronic  Myelitis 
— Chronic  Stage  of  Poliomyelitis — Chronic  Stage  of  Acute  Myelitis — 
Chronic  Degenerative  Spinal  Diseases — Spastic  Spinal  Sclerosis  or  "Lat- 
eral Sclerosis" — Combined  Spinal  Scleroses — Ataxic  Paraplegia — Mul- 
tiple or  Disseminated  Sclerosis — Hereditary  Spinal  Ataxia  or  Fried- 
reich's Ataxia — Amyotrophic  Lateral  Sclerosis — Chronic  Muscular 
Atrophies    336-360 

CHAPTER  XVIII. 

FUNCTIONAL  NERVOUS  DISEASES. 

Neurasthenia — Spinal  Irritation — Xervous  Dyspepsia — Hysteria — Epilepsy — 
— Chorea — Exophthalmic  Goitre — Headache — Migraine — Insomnia — Ver- 
tigo— Tinnitus  Aurii — Tinnitus  Cerebri — Sea  Sickness — Occupation  Neu- 
rosis— Professional  Xeurosis — Fatigue  Xeurosis — Writers'  and  Other 
"Cramps" — Paralysis  Agitans — Parkinson's  Disease — Shaking  Palsy — 
Facial  Spasm — Mimic  Tic — Spasmodic  Torticollis — Wry  Xeck — Spas- 
modic Tics — Habit  Spasm — Insolation — Sunstroke — Heatstroke — Ther- 
mic  Fever — Cerebral    Hyperemia 361-414 

CHAPTER  XIX. 

MEXTAL  DISEASES. 

Mania— Melancholia— Confusional  Insanity — Paranoia — Chronic  Delusional 
Insanity— Monomania — Folie  Raisonnante — Primare  Verruechtheit— De- 
mentia  Precox — Paresis    41 5-434 

CHAPTER  XX. 

DRUG  HABITS. 

Morphine — Cocaine — Chloral — Cannabis  Indica — Tobacco  Habit — Coffee— 
Tea 435-456 


CONTENTS.  xi 

i   M  AITKR   XXI. 

ALCOHOLISM. 

Acute  Alcoholic  Intoxication  (Drunkenness)— Acute  Alcoholic  Mania 
(Mania  a  Potu)— Acute  Alcoholic  Delirium  (Delirium  Tremens)— 
Chronic  Alcoholism— Chronic  Drunkenness  and  Inebriety— Pathological 
Anatomy— Treatment— Prophylaxis  of  Alcoholism 457-498 

CHAPTER  XXII. 

REARING  THE    DELICATE,  TUBERCULAR  AXD   NEUROPATHIC 

CHILD    4"-504 

CHAPTER  XXIII. 

DISEASES  OF  WOMEX. 

Vulvitis— Pruritus  Vulvae— Vaginismus  and  Vulvo-Vaginal  Hyperesthesia- 
Vaginitis  —  Amenorrhea  —  Dysmenorrhea  —  Endometritis  —  Metritis— 
Chronic  Endometritis— Chronic  Metritis— Uterine  Displacements— Uter- 
ine Hemorrhage— Menorrhagia  and  Metrorrhagia— Abortion— Eclampsia 
—Salpingitis— Acute  Oophoritis— Chronic  Oophoritis— Pelvic  Cellulitis 
and  Pelvic  Peritonitis— Pelvic  Pain  and  Pelvic  Congestion— Sterility- 
Menopause — Treatment     305-532 

CHAPTER  XXIV. 

GENITO-URINARY   DISEASES  AXD   SYPHILIS.     DISEASES  OF  THE 

RECTUM. 

Urethritis  —  Gonorrhea  —  Epididymitis  —  Orchitis— Prostatitis,  Acute  and 
Chronic— Spermatorrhea— Sexual  Neurasthenia— Impotence— Priapism— 
Neuroses  and  Neuralgia— Syphilis— Lues— Pox— Cachexia— Mercurialism 

—Suppression  of  Urine— Cystitis— Irritable  Bladder— Atony  of  the  Blad- 
der—Enuresis— Enuresis  Nocturna— Retention  of  Urine— Fissure  of  the 
Anus  and  Irritable  Ulcer  of  the  Rectum— Sphincterismus— Rectal  Pro- 
lapse— Hemorrhoids     533-354 

CHAPTER  XXV. 

DISEASES  OF  THE  SKIN,  EYE  AXD  EAR. 

Urticaria  —  Eczema— Pemphigus  —  Herpes  Simplex  —  Herpes  Zoster— Acne 
— Psoriasis  —  Dermatitis  —  Burns — Furuncle— Carbuncles  —  Comedo— 
Milium— Alopecia— Alopecia  Areata— Hyperidrosis— Anidrosis— Sudam- 
ina— Miliaria— Seborrhea— Pruritus— Bed  Sores— Cold  Hands  and  Feet 
—Leprosy — Skin   Diseases  in   General — Eye  and  Ear 555-579 

CHAPTER  XXVI. 
HYDROTHERAPY  IN  SURGERY. 
Contusions— Sprains— Dislocations— Fractures  —  Spinal  Curvature— Angular 
Curvature  of  the  Spine— Pott's  Disease— Spondylitis— Caries— Surgical 
Shock— Hemorrhage— Surgical  Fever— Abdominal  Surgery— Synovitis, 
Acute  and  Chronic— Arthritis— Exudates  in  Joints— Adhesions  of  Joints 
—Contractures  of  the  Joints— Ankylosis— Ulcer— Gangrene— Septic  In- 
fection—Osteitis—Periostitis —  Osteoperiostitis— Osteomyelitis— Appen- 
dicitis     580-598 


LIST   OF    ILLUSTRATIONS. 

PACK 

PLATE 

■) 
1 — Baths   of   Caracalla 

2— Strigilli    2 

3 — Farnese  Statuary  :   Hercules,  Bull,  Faun 4 

A — Hydrotherapeutie    Masters    • 

5— The  Early  Methods  of  Piressnitz  (Kellogg) ..." 8 

6— The  Early  Methods  of  Priessnitz  (Kellogg) 1(i 

7— The  Early  Methods  of  Priessnitz  (Kellogg) 1() 

8 — Microscopic   Section   of    Skin 

9— Microscopic  Section  of  Skin  Injected,  Showing  Skin  Circulation 14 

10—  Microscopic  Section  of  Skin.  Showing  Sebaceous  Glands 16 

11— Microscopic  Section  of  Skin,  Showing  Glandular  Structures 16 

12— Normal  Fatigue  Curve  of  Man,  Aged  Twenty-four  Years  (Kellogg)..  44 

13— Fatigue  Curve  of  the  Same  Subject  After  a  Hot  Bath  (Kellogg) 44 

14— Normal   Fatigue   Curve    ™ 

IS— Open   Air  Gymnasium    (Kellogg) °4 

16— Open  Air  Gymnasium    (Kellogg) 64 

16a— Indoor    Sun    Bath    (Kellogg) 62 

17— Incandescent  Electric  Light  Bath 66 

18— Incandescent  Electric   Light   Bath.    Horizontal 66 

19— Incandescent  Electric  Light  Bath,  Horizontal  ( Kellogg) 68 

20— Incandescent  Electric  Light  Bath,  Closed  ( Mott) , >0 

21— Incandescent  Electric  Light   Bath,  Open    (Mott) 70 

22— Local  Incandescent  Electric  Light  Baths  (Kellogg) 70 

23— Light  and  Arc  Cabinet  Combined,  Open  (Monell) 72 

2A — Light  and  Arc  Cabinet  Combined.  Closed   ( Monell ) 72 

25— Superheated  Dry  Hot  Air,  Body   Apparatus;   Sliding  Table  Tilted  to 

Show    Openings    

26— Superheated  Dry  Hot  Air.  Body  Apparatus;  Ready  for  Patient 76 

27— Superheated  Dry  Hot  Air,  Body  Apparatus;   Patient  in  Position  to  be 

Slid   Into  Cylinder    78 

28—  Superheated  Dry  Hot  Air,  Body  Apparatus ;  Patient  Taking  Treatment.  78 
39_ Superheated  Dry  Hot  Air;  Local  Application:  Foot  Bandaged  in  Turk- 
ish Toweling  Ready  to  be  Introduced 80 

30— Superheated  Dry  Hot  Air  ;  Treating  Foot 80 

31— Superheated  Dry  Hot  Air  ;  Treating  Hand  and  Arm SO 

32— Suoerheated  Dry  Hot  Air;  Treating  Knee  with  Special  Apparatus   for 

on 

this  Joint °" 

33— Superheated  Dry  Hot  Air  :  Treating  Hip 82 

34— Superheated  Dry  Hot  Air ;  Treating  Back 82 


35 — Hot   Air   Cabinet. 


84 


36— Hot  Air  Cabinet  in  Use 84 

37_Chapman's   Spinal   Ice   Bags;    Chapman's    Double   Column    Spinal    Hot 

Water  Bag ;   Ordinary   Hot  Water  Bottle 86 

38— Friction  with  Flesh  Brush 8tS 

39— Salt  Rub  or  Glow 9° 

40— Author's    Plan    


40a — Diagram  of  Hydriatic  Room   (  Mott ) 
xiii 


108 


xiv  LIST  OF  ILLUSTRATIONS. 

PLATE  PAGE 

41 — Water    Cooling    Device 112 

42 — Tobey's  Automatic  Water  Heater;  Soap  Dish;  Towel  Rack  (Mott)....  110 
43 — Bath    Room    Accessories ;     Pitcher ;     Salt    Jar ;    Thermometer ;     Fibre 

Bucket ;  Bath  Room  Floor  Slats 110 

44 — Ice  Cap  or  Helmet ;  Steam  Kettle 112 

45 — Sponge  or  Towel  Bath 114 

46 — Alternate  Hot  and  Cold  Sponge  to  Spine 116 

47 — Dripping  Sheet — Ready  '. 118 

48 — Dripping  Sheet — First  Stage 118 

49 — Dripping  Sheet — Second  Stage   118 

50 — Dripping    Sheet — Completed    118 

51 — The  Fomentation — Ready   120 

52 — The  Fomentation — Pouring  the  Boiling  Water 120 

53 — The   Fomentation — Removing   Water   with   Wringer 122 

54 — The  Fomentation — Removing  Water  by  Using  a  Twisted  Towel 122 

55 — The  Fomentation — In  Position   122 

56 — The    Fomentation — Completed    122 

57 — Stimulating  Compress — Compress  in  Position 124 

58 — Stimulating  Compress — Completed    124 

59— Coil  Cap  to  Head 124 

60 — Precordial  Compress  and  Ice  Bag — The  "Hydrotherapeutic  Digitalis"..  124 

61 — Chest  Compresses   128 

62 — Chest  Compress — First  Stage   128 

63 — Chest    Compress — Second    Stage    128 

64 — Chest  Compress — Completed    128 

65 — Permanent   Throat    Bandage 126 

66 — Joint    Compress    126 

67 — Throat  Compress  126 

68— Pelvic  Pack— Ready   130 

69— Pelvic  Pack— First  Stage   130 

70 — Pelvic  Pack — Second  Stage 130 

71— Pelvic  Pack— Completed   130 

72— Full  Wet  Pack— First  Stage 132 

73— Full  Wet  Pack— Second  Stage 132 

74_Full  Wet  Pack— Third  Stage 132 

75— Full  Wet  Pack— Fourth  Stage 132 

76— Full   Wet   Pack— Fifth   Stage 134 

77— Full  Wet  Pack— Sixth  Stage 134 

78— Full  Wet   Pack— Seventh   Stage 134 

79— Full  Wet  Pack— Completed 134 

80— Half  Wet  Pack    136 

81— Hot   Blanket    Pack    136 

82— Foot   Bath    140 

83— Sitz  or  Hip  Bath  Tubs 142 

84— Sitz  or   Hip   Bath 142 

83— Half   Bath    146 

86 — Affusion  to  Back  and  Spine 146 

87— The  Continuous   Bath    156 

88— The  Continuous  Bath  158 

88a— The  Continuous   Bath    160 

89 — Continuous  Bath,  or  Bathing  at  Leukebad,  Switzerland 162 

90 — Diagram  of  Cardiac  Area  of  Dullness  Before  and  After  Nauheirn  Bath,  164 

91— Portable  Bath  Tubs 166 


LIST  OF  ILLUSTRATIONS.  xv 

PLATE  PAGE 

92 — Patiom  in   Deflated  Tub 168 

93— Inflating   the   Tub 16S 

94 — Nurse  Applying   Friction    170 

95— Drawing  Off  the  Water 170 

96— Drying  Patient   172 

97 — Removing  Tub    172 

97a— Plunge  Tub   174 

98— The  Surf— Nature's  Douche    176 

99— Surf    Bathing    178 

100 — Coliseum  Swimming  Pool,  Louisville,  Ky 178 

101 — Author's    Douche   Apparatus 180 

102— Douche  Table    182 

103— Douche    Table    ( Baruch)    182 

104— Mydriatic    Room    182 

105— Shower    Baths    184 

106— Affusion  to  Chest    184 

107 — Circular,  Horizontal,  Rain  or  Needle  Bath 184 

108 — Perineal    Douche  Apparatus    186 

109— Perineal   Douche    186 

110 — To  Show  Compact  Arrangement  of  Horizontal  Rain  or  Needle  Bath, 

Triangle,  Perineal  Douche  and  Shower  Bath 188 

1 1 1— Fan   Douche    188 

1 12 — Fan    Douche  to   Spine 188 

1 13— Jet    Douche    190 

114 — Jet   Douche  to   Spine 190 

1 15— Scottish  or  Alternate  Douche 190 

1 16 — Scottish  or  Alternate  Douche  to  Spine 190 

1 17— Shower    Bath    192 

118— Portable  Bath  Tub   (Mott) 198 

119— Brand  Bath— First   Stage   (Cohen's  "Physiological  Therapeutics") 200 

120— Brand  Bath— Second  Stage  (Cohen's  "Physiological  Therapeutics") ...  200 

121— Brand  Bath— Third  Stage  (Cohen's  "Physiological  Therapeutics") 202 

122— Brand  Bath— Fourth  Stage  (Cohen's  "Physiological  Therapeutics")...  202 

123— Tent  Village,  Fort  Stanton,  N.  M.   (Carrington) 270 

124— "Easy  Street,"  Fort  Stanton,  N.  M.   (Carrington) 272 

125— A  Row  of  Six  Tent  Houses,  Fort  Stanton,  N.  M.  (Carrington) 274 


PRACTICAL    HYDROTHERAPY. 


CHAPTER    I. 
HISTORY  OF  HYDROTHERAPY. 

Hydrotherapy  had  its  birth  in  the  mists  of  antiquity,  for  bathing 
is  probably  as  old  as  the  hills  themselves.  From  the  most  ancient 
of  times  water  has  been  used  as  an  agent  in  the  treatment  of  dis- 
ease, probably  because  it  is  so  universally  found,  is  easy  of  applica- 
tion, and  because  of  the  relief  which  has  been  so  frequently  obtained 
by  its  use.  .  The  ancient  Hindus,  Persians,  Hebrews,  Egyptians  and 
Greeks,  all  employed  water  in  the  treatment  of  various  diseases,  and 
in  the  Vedas  of  Susrotas  water  is  often  spoken  of  as  an  article  of 
treatment  and  as  an  antidote,  the  number  and  time  of  the  bath  being 
exactly  regulated.  That  they  attached  importance  to  the  subject  is 
shown  by  the  minuteness  of  detail  which  is  given.  The  Magi  of 
the  Persians  and  Chaldeans  utilized  water  in  their  therapeutic  prac- 
tice, and.  as  we  read  of  holy  wells  in  the  neighborhood  of  their  tem- 
ples, it  certainly  played  no  unimportant  role.  The  ancient  Egyp- 
tians worshiped  the  Nile,  as  the  Hindus  did  the  Ganges,  and  they 
thought  that  bathing  in  its  waters  served  to  produce  fertility  alike 
in  the  land  and  in  sterile  women. 

It  was  in  Greece  that  water  first  reached  its  highest  repute ;  and 
here  Homer  sings  of  bathing;  Hector,  wounded,  finds  recovery  by 
means  of  water.  In  the  midst  of  groves  near  springs,  temples  were 
erected  in  honor  of  Asklepios,  the  Greek  god  of  the  healing  art ;  they 
were  always  located  in  airy,  sheltered,  healthy  places,  and  were  pro- 
totypes of  the  modern  sanatorium.  They  were  distinguished  from 
other  temples  by  their  simplicity  and  spaciousness.  The  temple 
proper  was  usually  very  small,  containing  merely  the  statue  of  Asklep- 
ios, sometimes  accompanied  by  his  daughter  Hygeia.  This  was  sur- 
rounded by  open  colonnades  where  the  suppliants  gathered.  There 
was  always  a  sacred  spring  at  the  entrance  to  the  temple.  As  the 
god  was  said  to  have  been  born  in  Epidaurus,  the  temple  there  was 
the  most  extensive  of  all.  The  walls  were  lined  with  bas  reliefs,  some 
still  well  preserved,  portraying  the  return  to  health,  or  gratitude  for 
recovery,  of  the  flocking  pilgrims,  or  of  entire  cities.  The  temple 
contained  also  statues  of  the  healed  persons,  or  of  the  healed  part 


2  PRACTICAL  HYDROTHERAPY. 

of  the  body,  statues  of  the  head,  hand,  foot,  breasts,  shoulder,  hip, 
etc.,  classified  as  to  groups,  which  must  have  given  the  temple  the 
appearance  of  a  pathologic  museum.  Other  votive  offerings,  urns, 
vases,  seats,  filled  some  of  the  rooms,  and  hung  from  the  ceilings, 
some  of  them  costly  gold  and  silver  articles  set  with  jewels,  which 
were  despoiled  later  by  the  Roman  conquerors;  the  temple  is  now  an 
empty  ruin.  The  priests  who  had  charge  of  these  temples  acquired 
a  certain  insight  into  the  medical  sciences  in  time,  and  were  able  to 
cure  many  of  the  applicants.  They  refused  to  admit  persons  with 
contagious  diseases,  or  in  an  advanced  stage  of  any  disease,  and  it 
was  forbidden  to  deliver  a  woman  even  in  the  environment  of  a 
temple.  Aristophanes  gives  a  graphic  description  of  the  application 
of  a  sick  person  for  relief.  He  first  had  to  bathe  in  the  sacred 
spring,  and  then  make  an  offering  to  the  god.  Each  party  had  to 
supply  his  own  wants,  as  the  temple  offered  nothing  but  a  bed  of 
dried  leaves  under  the  colonnade.  The  priests,  as  darkness  approached, 
went  through  a  certain  ritual  to  impress  the  patients  with  a  sense  of 
mystery  and  of  the  nearness  of  the  god.  The  priests  advised  cer- 
tain gymnastics,  riding,  hunting,  and  similar  sports;  in  others,  cheer- 
ing music,  singing,  etc.,  hydrotherapy,  including  running  barefoot 
in  the  grass,  and  numerous  hygienic  and  therapeutic  measures.  Thus 
it  was  that  mystical  methods  of  prayer,  and  cleansing,  and  strict 
fasting,  prepared  the  devotee  for  the  application  of  the  cold  water 
cure.  Here  it  was  that  Hippocrates,1  the  father  of  systematic  medi- 
cine, was  first  fired  with  enthusiasm  by  a  perusal  of  the  votive  tablets, 
and  undertook  the  study  of  this  agent  with  a  view  to  its  systematic 
use  for  medical  treatment.  Hippocrates  belonged  to  the  tribe  of  the 
priests  of  Asklepios,  but  emancipated  himself  from  its  methods 
and  teachings.  "He  was  the  first  to  maintain  that  cold  water 
warms,  while  warm  water  cools  the  body.  He  was  acquainted 
with  the  shower  bath  and  shampooing,  and  showers  to  induce  sleep. 
Cold  water  poured  over  the  body  he  found  useful  in  fainting.  He 
treated  tetanus  with  showers,  and  in  affections  of  the  joints  he  recom- 
mends the  pouring  over  of  cold  water  as  being  useful  in  relieving 
the  pain  and  curing  the  affection.  .  .  .  Elevation  of  temperature 
was  known  to  him  as  a  symptom  of  fever,  and  he  recommended  the 
use  of  cold  water  against  the  different  varieties  of  it."2  That  he  had 
an  excellent  understanding  of  the  physiological  action  of  water  is 
readily  appreciated  when  we  find  that  he  directed  cold  baths  to  be 
of  short  duration,  preceded  and  followed  by  friction,  thus  showing 
that  he  understood  the  advantages  of  prompt  reaction. 

Asclepiades  of  Prusa,  in  febrile  diseases,  ordered  cold  water  to 
be  drunk,  and  repeatedly  praises  the  value  of  the  cold  bath,  of  the 

1  See  illustration.     Courtesy  cf  Interstate   Medical  Journal. 

2  Winternitz,    Wm. :    "Hydrotherapy,"    Vol.    IX,   Ziemssen's   Cyclopedia   of   Therapeutics. 


O  0  OOBOOODOOOOOODOOOOOOOQDOO   OOOOQQOOOOOOOOaOIOQOtOOQOQ  O 

^iniiiiiiTiiimnnTmiTinHiiTuwiuninnM 


Plate   1 — Baths  of  Caracalla 


Plate  2 — Strigilli. 

Courtesy   Metropolitan   Museum   of   Art.    New    York   City. 


HISTORY  OF  HYDROTHERAPY.  3 

douche,  rain  baths  and  shampooing.  In  Rome,  cold  water  treatment 
obtained  a  permanent  place  in  the  science  of  medicine,  owing  to  the 
fact  that  Antonius  Musa  cured  the  Emperor  Augustus  by  means  of 
its  application.  But  it  was  in  the  degenerate  and  luxurious  period  of 
Cesarean  Rome  that  bathing  reached  the  maximum  of  its  ancient 
usage.  From  a  personal  study  of  the  great  Thermae  of  Rome  and 
Pompeii,  the  writer  was  astounded  at  their  extent  and  the  perfection 
of  equipment  of  these  most  ancient  bath  houses.  The  Thermae  of 
Caracalla,  or  Antoninianae,  were  erected  about  212  B.C.  by  the 
Emperor  Caracalla,  and  completed  by  Severus.  Their  magnificence 
was  unparalleled,  and  of  such  extent  that  they  could  accommodate 
sixteen  hundred  bathers  at  once.  They  were  built  mostly  of  red 
and  orange-colored  brickwork,  and  were  supplied  with  water  from 
the  Antonine  Aqueduct,  which  brought  water  to  the  baths  for  that 
special  purpose.  The  object  of  their  erection  by  the  emperors  was 
to  ingratiate  themselves  with  the  people;  and  in  the  construction  of 
these  enormous  buildings  they  equipped  them  with  private  bathing 
apartments,  gymnasia,  libraries,  and  sometimes  even  theatres.  This 
establishment  was  quadrangular  in  form,  surrounded  by  a  wall,  had 
its  porticoes  and  race  course. 

The  technical  effort  displayed  by  the  Roman  architects,  in  ren- 
dering impervious  to  moisture  the  walls  and  sides  of  their  reser- 
voirs, in  constructing  flues  for  the  conveyance  of  hot  air,  and  in 
conveying  and  heating  water,  showed  a  skill  of  the  very  highest 
order.  The  water  was  heated  ingeniously.  The  heat  which  was 
not  taken  up  by  the  first  boiler  passed  on  to  the  second,  and,  instead 
of  being  wasted,  helped  to  heat  the  second — a  principle  which  has 
only  lately  been  introduced  into  modern  furnaces.  We  enter  first 
(see  cut)  the  spacious  oblong  surrounded  by  columns  (peristyle), 
and  from  there  the  bathers  retired  to  the  Spoliatorium,  where  they 
undressed.  From  here  the  bather  entered  the  Tepidarium,  where 
he  remained  for  a  short  while,  then  passed  into  the  Unctuarium,  to 
be  anointed  with  oils  or  unguents,  and  then  into  the  Calidarium,  or 
hot-air  bath.  From  the  Calidarium  the  bather  entered  the  Suda- 
torium, or  sweat  room,  which  usually  had  large  vessels  containing 
hot  water,  from  which  the  bathers  sprinkled  themselves  while  rub- 
bing off  the  perspiration.  The  temperature  of  the  Sudatorium  was 
regulated  by  drawing  up  or  down  a  metallic  plate.  The  richer  Ro- 
mans used  a  variety  of  oils  and  pomades  ( smegmata)  ;  they  scarcely 
had  true  soaps.  The  poorer  class  had  to  be  content  with  the  flour 
of  lentils,  an  article  used  in  this  day,  for  the  same  purpose,  by  Ori- 
entals. The  most  important  bath  utensil  was  the  strigillus,  a  curved 
instrument  made  of  metal,  with  which  the  skin  was  scraped  and  all 
sordes  removed. 


4  PRACTICAL  HYDROTHERAPY. 

After  this  he  proceded  to  the  Solium,  or  cold  bath,  from  which  he 
emerged  to  be  rubbed  and  anointed. 

"Petronius  woke  only  about  midday,  and.  as  usual,  greatly  wearied. 
The  evening  before  he  had  been  at  one  of  Xero's  feasts,  which  was 
prolonged  till  late  at  night.  For  some  time  his  health  had  been  fail- 
ing. He  said  himself  that  he  woke  up  benumbed,  as  it  were,  and 
without  power  of  collecting  his  thoughts.  But  the  morning  bath 
and  the  careful  kneading  of  the  body  by  trained  slaves  hastened 
gradually  the  course  of  his  slothful  blood,  roused  him,  restored  his 
strength,  so  that  he  issued  from  the  elseothesium,  that  is,  the  last 
division  of  the  bath,  as  if  he  had  risen  from  the  dead,  with  eyes 
gleaming  with  wit  and  gladness,  rejuvenated,  filled  with  life,  exqui- 
site, so  unapproachable  that  Otho  himself  could  not  compare  with 
him,  and  was  really  that  which  he  had  been  called — arbiter  clcgan- 
tiarum."     (  Sienkiewicz,  "Quo  Yadis.") 

Bathed,  anointed,  perfumed,  in  state  and  stately  toga,  he  might 
then  enter  the  Stadium  and  mingle  with  the  literati  and  philosophers, 
listen  to  their  discourses,  and  discuss  the  latest  news.  Such  was  the 
magnificence  and  luxury  of  these  Thermae  that  one  stands  almost 
lost  in  the  contemplation  of  their  ancient  grandeur. 

An  idea  of  the  magnificence  of  these  baths  may  be  obtained  by 
a  glance  at  some  of  the  statuary  taken  from  this  Therma,  and  known 
as  the  Farnese  collection — the  Bull,  the  Hercules,  and  Faun — also 
the  Torso  Belvidere,  a  statue  so  perfect  in  its  anatomy  that  [Michael 
Angelo  declared  that  he  owed  his  power  of  representing  the  human 
form  divine  to  its  lines,  and  who,  in  his  blind  old  age,  used  to  be 
led  up  to  it  that  he  might  pass  his  hands  over  its  surface  and  still 
enjoy,  through  touch,  the  grandeur  of  its  muscles. 

"The  walls  of  the  lofty  apartments  were  covered  with  curious 
mosaics,  that  imitated  the  art  of  the  pencil  in  elegance  of  design  and 
in  the  variety  of  their  colors.  The  Egyptian  granite  was  beautifully 
encrusted  with  the  precious  green  marble  of  Xumidia.  A  perpetual 
stream  of  hot  water  was  poured  into  the  capacious  basins  through 
many  wide  mouths  of  bright  and  massive  silver;  and  the  meanest 
Roman  could  purchase,  with  a  small  copper  coin,  the  daily  enjoyment 
of  a  scene  of  pomp  and  luxury  which  might  excite  the  envy  of  the 
kings  of  Asia."  (Gibbons,  "History  of  the  Roman  People.")  Per- 
petual streams  of  water  poured  forth  on  all  sides  from  the  mouths 
of  lions  of  bright  and  polished  silver.  "To  such  a  pitch  of  luxury 
have  we  reached,"  says  Seneca,  "that  we  are  dissatisfied  if  we  do 
not  tread  on  gems  in  our  baths." 

"Consuls,  emperors,  and  the  great  men  of  every  age  have  found 
no  better  way  of  immortalizing  their  memories  than  by  the  shifting, 
indestructible,  ever-new.  yet  unchanging,  up-gush  and  down-fall  of 
water.  They  have  written  their  names  in  that  unstable  element, 
and  proved  it  a  more  durable  record  than  brass  or  marble."  (Haw- 
thorne, "Marble  Faun.") 

'"The  habits  of  luxury  and  inertia  which  were  introduced  with 
the   magnificent   baths   of   the   Emperors,   were   among   the   principal 


HISTORY  OF  HYDROTHERAPY.  5 

causes  of  the  decline  and  fall  of  Rome;  and  the  vices  which  were 
encouraged  in  the  baths  found  their  reaction  in  the  impression  of  the 
early  Christians  that  uncleanness  was  a  virtue,  an  impression  which 
is  retained  by  several  of  the  monastic  orders  to  the  present  day. 
Thousands  of  the  Roman  youth  frittered  away  their  hours  in  these 
magnificent  halls,  which  were  provided  with  everything  which  could 
gratify  the  senses."     (Hare's  "Walks  in  Rome.") 

Galen,3  that  bright  light  of  medicine,  was  an  able  advocate  of 
baths,  especially  of  cold  water,  and  advised  cold  affusions  to  the  head 
while  the  body  was  immersed  in  warm  water.  Following  Galen  came 
the  period  of  the  Dark  Ages,  when  every  form  of  knowledge  suffered 
from  fraud  and  ignorance,  and  during  which  the  whole  world  met 
with  an  irreparable  loss  in  the  burning  of  the  great  library  at  Alex- 
andria. During  this  time  medicine,  science  and  art  were  lost;  the 
great  Roman  Empire  was  rent  asunder,  plundered  by  the  northern 
hordes,  and  it  is  not  until  A.  D.  525  that  we  find  any  evidence  of  a 
real  luminary  on  the  hydriatic  horizon.  Rejecting  all  systems  of 
medicine,  Alexander  of  Tralles  insisted,  "with  a  true  philosophical 
spirit,  which  would  do  credit  to  him  to-day.  that  the  physician  must 
depend  in  each  single  case  upon  the  age,  constitution,  and  natural 
powers  and  mode  of  life  of  the  patient,  as  well  as  upon  the  climate 
and  allied  conditions  and  effects  of  nature."  He  believed  in  the  pour- 
ing upon  the  body  of  cold  water,  and  in  friction. 

Drawing  the  curtain  of  charity  over  the  dark  and  barbaric  Middle 
Ages,  in  which  medicine,  and  with  it  hydrotherapy,  suffered  greatly, 
we  come  to  a  period  when  glimmerings  of  intelligence  appeared  in 
.the  distance.  In  the  hands  of  quacks  and  charlatans,  mixed  and 
mystified  by  magical  arts,  hydrotherapy  had  fallen  into  shameful 
disrepute  until  the  great  surgeon,  Ambroise  Pare,4  undertook  its  ref- 
ormation. With  unabated  zeal,  with  acute  and  accurate  observation, 
by  hard  labor,  he  investigated  its  merits,  especially  in  the  treat- 
ment of  wounds  and  fractures,  and  said:  "I  declare  that  it  is  not  the 
words  (of  the  incantation)  nor  the  cross  which  do  it,  but  the  water 
which  cleanses  the  wound,  and  protects  the  injured  limb  from  inflam- 
mation and  the  attack  of  other  fluids,  by  its  coldness"  (A.  Pare,  edit. 
Malgaigne.  quoted  by  Winternitz).  Passing  again  into  a  state  of 
innocuous  desuetude,  hydrotherapy  was  not  aroused  from  its  lethargy 
until  the  advent  of  Floyer's  work,  which  came  out  in  London,  in 
1697.  He  was  an  educated  English  physician,  and  his  books  passed 
rapidly  through  six  editions,  making  many  converts  at  home  and 
abroad.  He  gathered  in  his  books  the  data  of  preceding  writings, 
both  sacred  and  profane,  and  spoke  favorably  of  the  cold  bath,  and 

3  See   illustration.      Courtesy   of   Interstate   Medical  Journal. 

4  See  illustration.  Courtesy  of  the  Librarian  of  Congress,  from  a  stipple  engraving  by 
Win.  Hall,  from  the  original  picture  in  L'Ecole  de  Medecine  (Paris).  In  the  Portrait  Gal- 
lery of  distinguished  poets,  philosophers,  etc.     London,   1853,  Vol.   I,  page   155. 


6  PRACTICAL  HYDROTHERAPY. 

ascribed  the  increase  of  disease  to  the  neglect  of  its  use.  He  recog- 
nized the  advantage  of  making  the  patient  sweat  before  taking  the 
cold  bath,  and  used  wet  sheets  and  blankets  to  bring  this  about,  a 
method  frequently  employed  at  the  present  day,  under  the  appella- 
tion of  the  "wet  sheet  pack." 

Floyer's  writings  and  work  began  to  make  an  impression  upon 
the  medical  fraternity  of  Germany,  and  one  of  the  first  to  appreciate 
it  at  its  true  value  was  the  illustrious  Friedrich  Hoffman,  at  that  time 
one  of  the  foremost  clinicians  of  Europe ;  he  attached  much  value  to 
the  medicinal  action  of  water.  Examining  critically  into  the  value  of 
mineral  waters  in  general,  he  came  to  the  conclusion,  which  is  most 
generally  held  at  the  present  time,  that  the  action  of  them  is  almost 
entirely  due  to  the  pure  water  they  contain. 

In  his  observations  and  researches  he  noticed  the  behavior  of  tis- 
sues to  the  action  of  cold  water,  and  was  the  first  to  call  attention 
to  the  fact  that  tissue  tone  could  be  brought  about  by  these  appli- 
cations. 

The  writings  of  this  highly  educated  and  philosophic  physician 
left  their  imprint  upon  the  medical  thought  of  his  day,  and  while  he 
did  not  place  its  use  upon  any  scientific  or  rational  basis,  yet  he  brought 
its  advantages  to  the  notice  of,  and  made  them  clear  to,  the  thoughtful 
and  appreciative  physicians  of  his  time. 

The  Japanese  have  used  water  in  the  treatment  of  disease  for 
many  years,  and  it  is  stated  that  Dr.  Nakagami,  three  hundred  years 
ago,  recommended  its  use,  particularly  in  mental  and  nervous  dis- 
eases, while  the  same  authority  states  that  the  cold  bath  has  been  in 
use  in  Japan  for  nearly  eight  hundred  years,  especially  among  the 
native  country  physicians. 

In  1786  James  Currie5  became  much  impressed  with  the  impor- 
tance and  results  to  be  obtained  by  the  application  of  hydrotherapy, 
and  was  attracted  to  its  use  through  the  publication  of  a  fellow- 
countryman  by  the  name  of  Wright.  Possessed  of  a  naturally  philo- 
sophic and  critical  mind,  and  being  a  practical  physician,  it  was  not 
long  before  he  discovered  many  important  principles  relating  to 
hydrotherapy.  He  carried  out  quite  a  number  of  physiological  ex- 
periments, watching  each  case  carefully,  and  controlling  each  move 
in  his  treatment  by  means  of  thermometric  observations.  He  was 
fond  of  prescribing  the  free  drinking  of  large  quantities  of  cold 
water,  and  did  not  become  so  enamored  of  his  new  practice  as  to 
forget  the  use  of  medicine,  hygiene  and  dietetics.  He  employed  cold 
water  in  the  different  forms  of  the  exanthemata,  paralysis,  tetanus, 
convulsions,  etc. 

S  See  illustration.  Courtesy  of  the  Librarian  of  Congress,  from  a  stipple  engraving  by- 
William  Thomas  Fry,  from  a  miniature  by  Thomas  Hargreaves,  in  the  British  Gallery  of 
Contemporary   Portraits.      London,    1822,    Vol.    I.    page   71. 


Plate  4 — Hydrotherapeutic  Masters. 


HISTORY  OF  HYDROTHERAPY.  7 

Perhaps  the  modern  birth  of  hydrotherapy  took  place  with  the 
advent  of  Vincenz  Priessnitz.6  A  Silesian  peasant,  born  in  1799, 
he  began  early  in  youth  to  adopt  cold  water  applications  for  the  treat- 
ment of  sprains,  contusions  and  swelling  of  horses'  feet,  using  com- 
presses and  bandages.  He  was  peculiarly  gifted  with  a  clear  insight, 
marked  seriousness  and  genuine  talent,  and  was  much  above  the  aver- 
age of  his  countrymen,  having  received  a  fairly  good  education.  He 
was  unfortunate  enough  to  sustain  a  fracture  of  two  of  his  ribs,  and 
as  the  local  country  authority  could  not  bring  the  broken  ribs  into  a 
proper  position,  and  when  he  became  aware  that  he  would  have  to 
face  long  suffering  and  deformity,  Priessnitz  determined  to  effect 
his  own  cure.  "With  the  energy  so  natural  to  him,  he  first  of  all 
pressed  his  chest  against  the  corner  of  a  chair,  and,  holding  his 
breath,  he  then  brought  the  two  ribs  in  position  with  his  hands,  fix- 
ing them  there  by  means  of  a  dressing  formed  of  towels  steeped  in 
cold  water;  then  he  drank  water  copiously  and  repeatedly,  and  found 
himself  cured  in  a  short  time."  While  his  methods  were  crude,  and 
administered  without  much  discrimination,  we  can  pardon  this  when 
we  realize  that  he  possessed  no  physiological  knowledge,  nor  had 
he  the  advantage  of  a  medical  education,  or  even  being  medically 
well   read. 

He  soon  began  to  organize  his  various  measures  and  remedies 
into  a  system  which,  though  crude  and  empirical,  yet  resulted  in 
such  success  as  to  compel  attention  from  far  and  wid°  In  mr' y  in- 
stances his  successes  were  phenomenal,  particularly  a.r  he  treated 
every  one  in  the  same  manner,  without  regard  to  age  or  sex,  and 
without  attempting  a  diagnosis  of  their  disease.  His  routine  method 
of  treatment  was  to  place  his  patients  upon  a  rough,  coarse,  though 
non-irritating  diet ;  compelling  considerable  muscular  exertion,  the 
drinking  of  large  quantities  of  cold  water,  and  the  different  external 
applications  of  this  agent.  For  the  latter  purpose  he  used  general 
and  local  baths,  douches  and  friction,  compresses  and  packs,  some 
of  the  latter  lasting  as  much  as  six  hours ;  and  we  find,  about  1840, 
"that  he  could  accommodate  1,576,  which  number  grew  yearly  by 
new-comers  from  every  part  of  the  globe."  He  had  to  undergo  the 
usual  scoffing  of  the  medical  fraternity,  but  his  lay  success  was  such 
as  to  finally  draw  critical  attention  to  his  methods,  and  he  thus  paved 
the  way  for  educated  physicians  to  take  up  the  study  of  this  impor- 
tant remedy,  among  whom  was  the  noted  French  physician  Fleury, 
who  later  published  an  extensive  practical  treatise  upon  the  subject. 

Priessnitz  was  not,  as  he  is  believed  to  be,  the  father  of  hydro- 
therapy.    On  the  contrary,  we  find  Hallmann  stating,  in  the  preface 


6  See  illustration.  Courtesy  of  the  Librarian  ot  Congress,  from  a  wood  engraving  in 
Harper's  Magazine,  Vol.  LX,  page  187,  in  connection  with  an  article  on  "The  Isms  of  Forty 
Years   Ago." 


8  PRACTICAL  HYDROTHERAPY. 

of  his  work,  in  1843.  that  "thrice  already  has  hydrotherapy  offered 
its  service  to  medicine." 

Currie  announced  the  new  study,  and  gave  it  a  capital  recom- 
mendation ;  it  was  listened  to  by  many,  studied  by  few,  and  finally 
forgotten  by  all.  Hufland,  twenty  years  later,  tried  to  obtain  a  hear- 
ing for  it.  Still  twenty  years  later,  it  again  spoke  through  the  mouth 
of  a  layman,  Priessnitz.  Hydrotherapy  is  no  enemy  of  medicine; 
on  the  contrary,  it  prides  itself  on  being  the  daughter  of  the  old 
Hippocratical  medicine,  and  promises  to  be  a  powerful  ally  to  its 
mother. 

The  cuts  give  an  idea  of  some  of  the  local  and  general  applica- 
tions of  water  that  Priessnitz  used,  and  which  his  mechanical  ability 
enabled  him  to  change  or  modify  at  will.  Thus,  medicine  was  once 
again  to  be  compelled  to  accept  a  remedy  far  more  valuable  than 
nine  out  of  ten  medicinal  measures,  through  the  insistence,  persist- 
ence and  unquestionable  ability  of  an  ignorant  but  astute  layman. 
Too  often  has  this  been  the  case,  and  alas !  it  is  sometimes  true  in 
the  present  day  and  generation. 

Fleury  visited  Priessnitz.  and  was  so  much  impressed  by  the  re- 
sults obtained  by  this  empiric,  that  he  returned  to  France  to  take 
up  the  systematic  and  careful  study  of  hydriatic  methods.  His  aim 
was  to  examine  carefully  into  the  physiologic  and  therapeutic  value 
of  each  procedure,  and  it  might  be  stated  that  he  founded  almost  a 
separate  school  by  the  introduction  of  the  "douche."  He  was  a 
keen  observer,  a  thoughtful  man.  and  fortified  his  deductions  by 
clinical  results. 

In  1848  he  published  a  work  devoted  to  the  douche  and  its  appli- 
cation in  intermittent  fever,  to  be  followed  afterward  by  a  treatise 
in  which  he  showed  the  great  value  and  success  of  the  treatment 
of  pseudoanchyloses.  chlorosis  and  scrofula  by  the  same  means.  It 
is  astonishing  to  note  the  results  he  obtained  by  this  method. 

In  1850,  Hollman.  a  scientifically  educated  physician,  studying  the 
the  results  obtained  by  Priessnitz,  became  converted  and  entered  upon 
the  use  of  hydrotherapy.  He  sought  to  induce  perspiration,  in  addi- 
tion to  the  abstraction  of  heat,  by  wet  packing. 

To  Bocker  must  be  given  the  credit,  at  this  time,  of  the  most 
complete  experimental  investigation  of  the  internal  administration  of 
water,  winch  led  to  the  law  that  the  excretion  of  urea  increased  dur- 
ing the  copious  drinking  of  water,  while  the  formation  of  uric  acid 
is  diminished,  together  with  a  diminution  of  the  chlorides  and  phos- 
phates. 

In  1861.  Ernest  Brand,  of  Stettin,  published  the  details  of  his  now 
well  known  and  celebrated  treatment  of  typhoid  by  baths  at  a  tem- 
perature ranging  from  50°  to  68°  F.  It  would  be  impossible,  in  a 
historic  review,  to  more  than  mention  the  studies,  labors  and  results 


Plate  5 — The  Early  Methods  of  Priessnitz   (Kellogg). 


JIlSTOh'V  OF  HYDROTHERAPY.  9 

of  Brand,  and  this  matter  will  be  entered  into  more  fully  and  in 
detail  when  the  consideration  of  the  treatment  of  typhoid  fever  is 
taken  up. 

Suffice  it  to  say,  however,  that  his  studies  and  treatment  clearly 
showed  that  the  cold  bath  treatment  lowers  the  body  temperature, 
diminishes  the  grave  symptoms,  refreshes  and  strengthens  the  ner- 
vous system,  probably  shortens  the  course  of  the  disease,  and  lessens 
the  mortality. 

In  1863,  Dr.  John  Chapman,  an  Englishman  living  in  Paris, 
founded  the  application  of  the  spinal  ice-bag  upon  a  law  that  "paral- 
ysis of  the  sympathetic  nerves  brought  on  dilatation  of  the  vessels 
they  supplied,  and,  consequently,  peripheral  hyperemia,  with  real 
increase  of  temperature ;  whilst  irritation  of  the  sympathetic  ganglia 
brought  about  contraction  of  the  blood-vessels,  and,  consequently, 
anemia  and  lowering  of  temperature."  They  became  of  some  value 
in  the  treatment  of  spinal  and  nervous  diseases. 

It  was,  however,  to  Professor  William  Winternitz,7  of  Vienna, 
Austria,  that  the  credit  of  placing  hydrotherapy  upon  a  scientific 
basis  is  due.  This  investigator  brought  to  his  work  full  knowledge, 
a  discerning  mind,  and  an  enthusiasm  that  knew  no  bar,  nor  allowed 
any  difficulty  to  prevent  the  accomplishment  of  his  purposes.  His 
studies  upon  the  influence  of  hydrotherapy  upon  metabolism,  the 
blood,  oxretion.  the  application  of  heat  and  cold,  are  monuments 
of  scientific  care  and  pains,  while  his  deductions  show  the  logic  of 
a  true  investigator,  a  mind  of  broad  gauge  and  ample  qualification. 
It  was  through  his  investigations  that  we  are  able  to  know  definitely 
that  the  influence  of  cold  water  procedures  upon  the  nervous  system 
was  a  stimulus,  a  fact  of  much  more  importance  than  the  mere  phys- 
ical action  of  loss  of  heat.  With  this  knowledge  at  his  command, 
he  began  to  study  and  make  use  of  hydrotherapy  in  the  treatment 
of  the  different  forms  of  disease  that  came  under  his  care.  It  was, 
however,  not  until  1876  that  he  published  his  work,  and  described 
fully  the  influence  of  hydrotherapy  on  the  circulation  and  innerva- 
tion. The  author  here  acknowledges  not  only  his  indebtedness  to 
the  classic  studies  and  works  of  Prof.  Winternitz,  but  he  owes  to  the 
personal  charm  of  the  man  his  first  desire  to  study  and  investigate 
this  method  of  therapeutic  procedure.  The  observations  made  at 
his  clinic  remain  fresh  and  strong  among  the  many  recollections  of 
his  student  life.  It  was  through  Winternitz's  work  and  influence 
that  Vienna  has  become  the  great  modern  center  of  hydrotherapy, 
and  from  which  many  of  the  successful  results  of  treatment  have 
originated. 

Among  modern  physicians,  Dujardin  Beaumetz  has  placed  the 
stamp   of  his   approval   upon   the  use   of   hydrotherapy   in   its   many 

7  See  illustration.    Courtesy  of  Modern  Medicine  and  Bacteriological  Review,  June,  1902, 


10  PRACTICAL  HYDROTHERAPY. 

forms.  There  are  few  will  gainsay  the  experience  and  judgment 
of  Prof.  Erb  in  the  treatment  of  disease  within  his  specialty  (ner- 
vous diseases),  and  an  expression  of  opinion  from  one  who  is  en- 
tirely freed  from  the  vice  of  using  a  single  therapeutic  method  must 
be  doubly  felt  when  we  read  his  statement  made  in  Von  Ziemssen's 
Cyclopedia,  as   follows: 

"To  the  most  important  and  most  active  therapeutics  of  our  field 
belong  cool  and  cold  baths,  viz.,  the  application  of  cold  water  in  its 
most  varied  forms,  that  which  is  usually  termed  'cold  water  treat- 
ment.' Its  results  in  all  possible  forms  of  chronic  nervous  diseases 
are  extraordinarily  favorable.  If  we  add  to  this  the  heightened  skin 
and  muscular  action  induced  by  various  methods  of  bathing,  it  be- 
comes evident  that  we  possess  few  remedies  which  produce  an  equally 
powerful  effect." 

Of  recent  years  American  physicians  have  taken  up  the  subject 
of  hydrotherapy  and  its  associated  procedures,  and  have  constantly 
impressed  their  value  upon  the  profession  of  this  country. 

No  historical  review  of  hydrotherapy  would  be  complete  without 
a  tribute  to  two  American  masters  in  this  department — J.  H.  Kellogg 
and  Simon  Baruch.  These  men,  above  all  others,  have  stood  for  the 
honest,  scientific  and  practical  application  of  water  to  disease.  They, 
much  more  so  than  the  author,  for  they  have  worked  longer  in  the 
pioneer  field  than  he,  can  recall  all  the  difficulties  and  all  the  preju- 
dices that  met  their  early  efforts.  They  have,  fortunately,  lived  to 
see  the  day  when  the  profession  is  awakening  to  view  as  they  did 
a  valuable  and  powerful  therapeutic  weapon.  Their  studies  and 
contributions,  covering  three  decades,  will  ever  be  an  honor  to  Amer- 
ican hydrotherapy. 

Hydrotherapy  has  seen  its  ups  and  downs,  its  periods  of  fluctu- 
ation, its  cycles  of  existence  and  non-existence.  In  ancient  times  it 
was  used  only  to  be  lost,  and  later  revived  to  be  lost  again.  In  mod- 
ern medicine  hydrotherapy  has  come  to  stay,  and,  were  I  to  predict, 
I  would  certainly  say  that  it  will  never  again  reach  the  shades,  nor 
depart  from  the  usage  of  intelligent  physicians.  To-day  the  medical 
profession  is  too  broad  in  its  beliefs  to  permit  the  extinction  or  loss 
of  any  procedure  by  which  results  may  be  obtained;  and,  having 
been  freed  from  empiricism,  and  built  upon  the  strong  bulwark  of 
physiological  study,  we  may  hope  that  the  intelligent  medical  man 
will  never  again  allow  it  to  be  lost  sight  of,  but  will  use  it  as  one  of 
the  most  powerful  and  satisfactory  of  therapeutic  resources. 


hd 


*d 


- 


Plate  7— Early  Methods  of   Priessnitz    (Kellogg). 


CHAPTER   II. 

GENERAL    CONSIDERATIONS.— ANATOMY    AND    PHYSIOLOGY 

OF  THE  SKIN. 

Hydrotherapy  is  the  application  of  water  in  or  upon  any  part  of 
the  human  body  for  remedial  purposes.  It  is  a  remedy  that  requires 
a  thorough  and  practical  knowledge  of  anatomy  and  physiology.  When 
properly  handled  and  in  experienced  hands,  it  is  an  agent  capable 
of  producing  results  not  equalled  by  any  therapeutic  procedure  in 
the  domain  of  medicine.  In  its  application,  not  only  is  it  necessary 
to  know  physiological  function,  but  the  pathological  modification  of 
tissue  resulting  from  disease.  Of  all  physicians,  the  hydrotherapeu- 
tist  should  possess  an  accurate  knowledge  of  the  anatomy  and  physi- 
ology of  the  nervous,  skin  and  blood-vascular  systems. 

The  author,  while  possessing  the  most  thorough  appreciation  of 
the  advantage  and  value  of  hydrotherapy,  fully  realizes  that  it  is 
not  a  cure-all,  nor  is  it  intended  to  convey  such  an  idea.  The  great 
tendency  of  enthusiastic  therapeutists  to  lean  upon  one  single  method 
of  procedure  cannot  be  too  heartily  condemned,  and  it  is  with  a  full 
comprehension  of  the  real  value,  and  the  limitations  of  this  agent, 
that  this  book  has  been  written. 

It  will  be  noticed,  especially  in  the  therapeutic  portion  of  the 
volume,  that  other  methods  are  suggested  as  of  primary  importance, 
and  water  as  its  corollary,  and  vice  versa.  Too  often  enthusiasm  has 
carried  the  user  of  water  far  beyond  the  domain  of  truth,  and  it  is 
here  again  reiterated  that  its  true  and  full  value  is  developed  only 
in  the  hands  of  those  who  bring  to  it  a  just  and  scientific  apprecia- 
tion  of   its   limitations. 

It  is  an  agent  that  is.  or  should  be,  in  daily  use  from  birth  until 
death,  and  not  only  is  it  of  value  as  a  remedial  measure,  but  it  is 
a  useful  agent  in  the  preservation  of  health.  Its  application  in  the 
treatment  of  disease  is  an  art.  and  can  be  acquired  only  by  the  exer- 
cise of  experience.  Its  haphazard,  desultory  and  careless  application 
is  just  as  much  contraindicated  as  the  same  method  would  be  in  the 
prescribing  of  drugs.  Correct  diagnosis,  an  appreciation  of  the  clin- 
ical indications,  and  a  full  knowledge  of  the  physiological  action 
of  the  agent  used,  are  necessary  to  its  proper  use.  Many  methods, 
especially  in  acute  and  subacute  diseases,  require  little,  if  any,  appa- 
ratus;  and,  in  fact,  in  many  of  the  best  applications  in  these  condi- 
tions, the  paraphernalia  can  be  found  in  any  household,  even  the  hum- 


12  PRACTICAL  HYDROTHERAPY. 

blest.  It  is  in  the  domain  of  chronic  diseases  and  disorders  that  the 
more  bulky  and  non-portable  apparati  are  needed,  and  these  are  to 
be  found  in  institutions  devoted  to  the  treatment  of  this  class  of 
sufferers. 

The  Physical  Properties  of  Water. 

Water  is  a  constituent  of  every  tissue  of  the  human  body,  from 
0.2  per  cent,  in  the  enamel  of  the  teeth  to  99  per  cent,  in  the  tears. 
It  is  necessary  to  the  performance  of  every  function  of  the  organ- 
ism. In  its  fluid-like  form  water  lends  itself  readily  to  applications 
to  the  body.  The  physical  changes  to  which  it  may  be  subjected 
run  from  32°  F.,  ice,  to  212°  F.,  steam,  when,  under  ordinary  cir- 
cumstances, it  attains  a  volume  seventeen  hundred  times  greater,  and 
becomes  quite  elastic.  It  can  thus  be  readily  seen  what  an  enormous 
opportunity  is  offered  in  its  application  to  the  periphery  of  the  human 
body,  both  for  general  and  local  effects.  It  possesses  cleansing  and 
antiseptic  properties,  and  this  is  one  of  the  principal  uses  in  ordinary 
application.  The  physical  properties  of  water  in  its  hydrotherapeutic 
application  consist  of  the  following: 

1.  Thermic  Action. — Water  absorbs  more  heat  for  a  given  weight 
than  any  other  substance,  and  communicates  this  with  great  rapidity 
to  objects  with  which  it  comes  in  contact,  and  therefore  it  is  readily 
adapted  for  making  applications  of  varying  temperatures  to  the 
human  body.  The  ease  and  rapidity  with  which  we  may  vary  the 
thermic  influence  adds  to  its  efficiency.  General  therapeutic  applica- 
tions may  be  made  between  the  temperatures  of  34°  and  120°  F. ; 
locally,  34°  to  160°  F. ;  a  range  of  temperature  effects  unobtainable 
and  unequalled  by  any  other  known  remedial  measure. 

2.  Mechanical  Effects. — Water,  possessing  a  certain  weight,  makes 
it  possible  under  pressure  to  obtain  vibratory  or  mechanical  effects 
that  are  extremely  valuable  to  the  hydriatist.  The  forcible  impact 
of  water  of  varying  degrees  of  pressure,  influences  by  its  mechanical 
action  the  peripheral  nerve  endings  and  blood  supply,  independent 
of  the  thermic  action. 

3.  Adaptability. — The  ease  and  rapidity  with  which  this  agent 
may  be  changed  and  varied  in  a  precise  and  certain  manner,  so  that 
the  attendant  has  under  his  control,  within  a  few  seconds  of  time, 
the  temperature,  pressure,  form  of  application,  and  duration,  renders 
it,  without  question,  the  remedy  par  excellence  for  these  effects.  Its 
form,  size,  weight  and  fluidity  being  under  perfect  control,  makes  it 
adaptable  to  any  and  all  portions  of  the  body  with  a  precision  and 
satisfaction  offered  by  no  other  thermic  agent. 

4.  Cleansing,  Antiseptic  Action. — There  is  no  agent  equal  to  water 
in  its  cleansing  action,  and  the  daily  bath  is,  as  a  rule,  part  and  parcel 
of   civilized   mankind's   daily   routine.      As   an   antiseptic,   pure   water 


ANATOMY  AND  PHYSIOLOGY  OF  THE  SKIN.         13 

finds   its  uses   innumerable   in   the   surgical   and   medical   field,   while 
internally  it  is  not  only  an  antiseptic,  but  a  diluent. 

It  may  be  stated  that  water,  when  properly  used,  keeps  the  hody 
in  health,  prevents  the  onset  of  disease,  resists  the  attacks  of  patho- 
genic hacteria,  and  is,  as  Hoffman  says,  "more  nearly  a  panacea  for 
human  ills  than  any  other  known  agent." 

Anatomy  of  the  Skin. 

As  scientific  therapy  of  any  kind  should  he  based  upon  anatomi- 
cal and  physiological  considerations,  it  is  necessary  to  first  consider 
the  structures  and  functions  of  the  human  skin,  it  being  the  princi- 
pal organ  to  which  water  is  applied.  The  skin  is  tough,  flexible  and 
highly  elastic ;  it  consists  of  fibro-areolar  tissue,  contains  blood-ves- 
sels, lymphatics,  glands  and  nerves.  It  is  the  principal  seat  of  the 
sense  of  touch,  and  is  an  important  excretory  organ,  containing,  as 
it  does,  the  sweat  and  sebaceous  glands. 

The  skin  consists  of  two  layers: 

1.  The  corium,  or  cutis  vera. 

2.  The  epidermis. 

It  is  closely  connected  to  adjacent  parts  by  means  of  the  sub- 
cutaneous cellular  tissue,  into  which  the  follicles  of  the  hair  and  the 
different  glands  of  the  skin  project. 

The  true  skin  consists  almost  entirely  of  fibro-areolar  tissue; 
the  firm  white  fibrous  tissue  forming  with  the  yellow  elastic  fibers 
a  strong  framework  for  the  structures  of  the  skin.  This  tissue  is 
most  abundant  in  the  lower  layers  of  the  corium,  becoming  finer 
toward  the  surface. 

The  areolae  form  channels  by  which  the  blood-vessels,  nerves, 
glands,  etc.,  are  distributed  superficially,  and  the  interspaces  between 
these  are  usually  occupied  by  fat  cells.  Unstriped  muscular  fibers, 
abundant  in  the  upper  portion  of  the  cutis,  are  usually  located  around 
the  hairs.  Situated  near  the  free  surface  of  the  true  skin  is  the  papil- 
lary layer,  consisting  almost  entirely  of  blood-vessels.  These  papillae, 
or  projections,  rise  perpendicularly  to  the  surface,  and  are  highly 
sensitive. 

Their  number  and  distribution  vary  proportionately  with  the  sen- 
sitiveness of  the  skin ;  that  is  to  say,  the  more  sensitive  portions  being 
supplied  very  much  more  richly  with  papillae. 

The  larger  and  smaller  papillae  contain  a  capillary  loop,  convo- 
luted to  a  greater  or  lesser  extent,  and  in  addition  one  or  more  nerve 
fibers,  in  some  sections  intimately  associated  with  the  "tactile  cor- 
puscles." 

The  epidermis,  or  scarf  skin,  consists  of  many  layers  of  stratified 
epithelium,  molded  or  cemented  together.  These  cells  are  of  various 
sizes,  shapes  and  hardness,  the  inner  layer  being  soft  and  the  outer 


14  PRACTICAL  HYDROTHERAPY. 

hard.  The  superficial  cells  of  the  epidermis  are  being  constantly 
thrown  off  and  their  place  taken  by  the  newer  cells  of  the  deeper 
structure.  These  external  hardened  and  flattened  cells  are  removed 
in  great  numbers  after  a  bath  followed  by  friction.  The  epidermis 
serves  as  a  protective  layer  to  the  cutis,  and  prevents  and  limits  evap- 
oration from  the  blood-vessels  which  come  close  to,  or  against,  its 
inner  margin.  '  It  possesses  on  its  surface  lineal  markings  or  furrows 
of  variable  size  and  disposition,  the  projections  between  the  furrows 
depending  upon  the  peculiar  arrangement  of  the  papillae. 

The  blood  supply  of  the  skin  is  derived  from  arteries  located 
in  the  subcutaneous  tissue,  numerous  branches  of  which  pass  through 
the  areolae  of  the  cutis,  dividing  into  dense  capillary  plexuses,  from 
which  numerous  twigs  ascend  perpendicularly  into  the  papillary  layer. 
It  is  from  this  network  of  capillaries  that  the  glandular  structures 
and  the  hairs  are  likewise  supplied. 

The  gross  nerve  supply  to  the  skin  is  derived  from  the  cerebro- 
spinal system,  and  consists  of  medullated  and  non-medullated  fibers. 
They  are  distributed  over  the  entire  skin  in  relation  to  the  different 
spinal  segments.  The  nerve  fibrils  form  a  plexus  in  the  corium,  and 
from  this  plexus  neuraxons  ascend  to  be  distributed  to  the  papillae, 
and  to  terminate  in  the  corpuscular  bodies  associated  with  sensation. 
Fibrils  are  distributed  to  the  hair  follicles,  sweat  and  sebaceous 
glands.  The  nerve  supply  of  the  skin  is  most  extensive,  among 
which  are  fibrils  that  govern  temperature  (heat  and  cold),  touch, 
pain,  and  the  vasomotors. 

The  sudoriferous  or  sweat  glands  are  found  in  enormous  num- 
bers opening  upon  the  surface  of  the.  skin.  They  are  about  1-56  of 
a  line,  and  their  total  number  is  estimated  by  Krause  at  2,381,248. 
They  vary  in  number  per  scpaare  inch,  from  417  on  the  neck  and 
back  to  2,800  on  the  palms  of  the  hand.  They  are  found  in  the  small 
pits  in  the  corium,  and  extend  deeply  into  the  subcutaneous  cellular 
tissue,  being  usually  surrounded  by  a  quantity  of  adipose  tissue. 
They  are  lobulated  bodies  consisting  of  convoluted  tubes,  from  which 
a  duct  proceeds  through  the  true  skin  and  opens  upon  the  surface 
of  the  epidermis.  The  duct  is  usually  spiral  in  its  course,  and  opens 
upon  the  skin  in  a  more  or  less  oblique  or  valve-like  manner. 

The  sebaceous  glands  are  found  in  the  cutis  projecting  into  the 
subcutaneous  cellular  tissue.  These  are  small  sacculated  glandular 
organs,  consisting  of  a  single  duct  which  terminates  in  a  more  or 
less  racemose  manner  or  in  a  lobulated  pouch-like  extremity.  The 
duct  is  lined  with  epithelium  and  usually  filled  with  particles  of  seba- 
ceous matter,  which  constitute  its  secretion.  The  ducts  open  mostly 
into  the  hair  follicles,  but  in  some  positions,  as  in  the  face,  directly 
upon  the  general  skin  surface.  These  glands  are  most  abundant  in 
the   scalp,    face,   and    especially   around    apertures    where    there    is   a 


«A  :• 


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■-P./  '  f,   .  w- ■-,■/ 


11  t..J   [  ,  \l^ 


Plate  8 — Microscopic  Section  of  Skin. 


PlATe  9— Microscopic  Section  Injected,  Showing  Skin  Circulation. 


ANATOMY  AND  PHYSIOLOGY  OF  THE  SKIN.         15 

junction  of  the   skin   and   mucous  membrane;  they  are  absent  upon 
the  palms  of  the  hands  and    feet. 

Physiology  of  the  Skin. 

The  physiology  or  function  of  the  skin  may  be  considered  as 
follows : 

1.  As  a  protective  covering. 

2.  As  a  sensory  organ. 

3.  As  an  excretory  organ. 

4.  As  a  vascular  organ. 

5.  As  an  organ  for  the  regulation  of  heat. 

1.  Protective  Covering. — The  skin  and  its  subcutaneous  cellular 
tissue  not  only  fills  up  depressions,  covers  projecting  points  and  in- 
creases the  cosmetic  appearance  of  the  body,  but  serves  as  a  firm, 
easily  movable  and  soft  elastic  pad  to  protect  delicate  and  sensitive 
spots  from  external  and  mechanical  injury.  The  epidermis,  being  a 
dry,  horny  substance,  devoid  of  nerves  and  blood-vessels,  acts  as 
a  resistive  body  to  the  entrance  of  foreign  substances  from  without. 
Its  pressure  upon  the  capillaries  in  the  papillary  layer  prevents  evap- 
oration and  too  great  a  diffusion  of  liquids.  The  epidermis  is  a  bad 
conductor  of  heat,  watery  vapor  and  electricity. 

2.  Sensory  Organ. — This  is,  of  all.  the  greatest  function  of  the 
skin,  for  by  means  of  the  nerve  endings  terminating  upon  the  surface 
of  the  skin,  it  serves  the  purpose  of  bringing  the  human  organism 
into  contact  with,  or  conscious  of,  the  external  world.  Through  its 
nerve  supply  we  are  capable  of  feeling  the  contact  of  objects  with 
the  skin  (touch  or  tactile  sense),  the  varying  degrees  of  thermic 
change  (temperature  sense),  disagreeable  and  painful  sensations  (the 
pain  sense).  Tactile  sensation,  or  the  sense  of  touch,  as  previously 
mentioned,  is  mostly  served  through  utilization  of  the  touch  cor- 
puscles of  Wagner  and  Meissner,  Pacini  and  Golgi.  These  nerve 
terminations  are  capable  of  recognizing  specific  sensations  of  all 
kinds.  So  intimately  are  the  nerves  disposed,  that  in  all  portions 
of  the  body  the  slightest  touch  with  a  fine  cambric  needle  is  not  only 
appreciated,  but  pain  as  well  as  touch  is  felt. 

Modern  investigators  now  separate  the  nerve  endings  into  dis- 
tinct and  specific  points  for  the  recognition  of  the  different  sensa- 
tions, and  believe  that  there  are  specific  end-organs  which  appreciate 
the  varying  sensations  of  touch,  locality,  pressure,  pain  and  tempera- 
ture. The  intimate  association  of  the  skin  with  the  cerebro-spinal 
and  sympathetic  systems  of  nerves  makes  the  skin  an  organ  capable 
of  producing  the  profoundest  reflex  influences  upon  distant  organs 
and  functions,  and,  as  it  is  constantly  exposed  to  varying  conditions 
of  irritation,  so  does  it  produce  varying  influences  upon  different 
portions  of  the  body  by  means  of  its  referred  and  reflex  action.     The 


16  PRACTICAL  HYDROTHERAPY. 

study  of  the  minute  anatomy  of  the  spinal  cord  lends  additional 
belief  to  the  view  here  expressed,  that  these  sensations  are  subserved 
by  different  nerve  fibers,  which  are  ultimately  gathered  into  the  dif- 
ferent columns  functionally  related  to  these  sensations.  However, 
it  may  be  said  that  the  sensations  of  the  cutis,  while  different,  are 
yet  closely  united,  and  that  the  neural  mechanism  of  the  skin  is  dis- 
tinctly a  conjoint  and  complicated  one,  with  difficulty  of  separation, 
so  far  as  its  sensory  impressions  are  concerned.  The  sensibility  of 
the  skin  is  greatly  influenced  by  certain  conditions,  which  should  be 
borne  in  mind  by  the  hydriatist. 

Exercise  and  moistening  of  the  skin  increase  its  acuteness  and 
activity.  The  temperature  sense  of  the  skin  is  very  much  more  acute, 
rapid  and  exact  for  cold  than  for  heat ;  in  fact,  heat  sensations  are, 
as  a  rule,  developed  slowly  and  less  accurately.  Sudden  change  from 
one  temperature  to  another,  especially  from  heat  to  cold,  is  felt  more 
acutely  than  the  reverse ;  the  application  of  heat  followed  by  that 
of  cold  is  of  a  more  stimulating  effect  than  vice  versa.  Temperature, 
especially  cold,  is  felt  more  acutely  if  it  is  accompanied  by  weight 
or  pressure,  and  may  reach  such  a  point  as  to  be  in  either  event 
painful.  The  terms  heat  and  cold  are  purely  relative ;  a  body  possess- 
ing a  sensation  of  warmth  when  heat  is  communicated  to  the  skin, 
and  is  felt  as  cold  when  it  robs  the  skin  of  heat.  The  body  appre- 
ciates varying  degrees  of  temperature  in  proportion  to  the  richness 
of  the  nerve  supply.  Practice  develops  the  temperature  sense,  and 
brings  forth  a  more  accurate  and  acute  appreciation  of  its  influences. 
When  large  areas  of  the  skin  are  brought  in  contact  with  bodies  of 
varying  temperature,  the  sensation  is  felt  more  sensibly  than  if  the 
area  is  small. 

Pain  may  occur  whenever  a  strong  stimulus  is  applied  to  a  sen- 
sory nerve.  All  kinds  of  stimuli  may  produce  pain  provided  they  are 
stronger  than  normal ;  thus,  mechanical,  thermic,  chemical,  electrical 
or  somatic  disturbances  may  produce  pain.  The  intensity  of  the 
pain  usually  depends  upon  the  excitability  of  the  sensory  nerves,  the 
extent  of  the  stimulus  and  its  degree. 

3.  Excretory  Organ. — The  most  important  secreto-excretory  func- 
tions of  the  skin  are  (a)  sudoriferous,  (b)  sebaceous,  (c)  respiratory. 

Sweat,  the  secretion  of  the  sweat  glands  above  described,  is  se- 
creted in  the  coil  of  the  gland,  and  finds  its  exit  upon  the  skin. 
Under  ordinary  circumstances  it  is  secreted  in  such  quantities  that 
when  it  reaches  the  surface  of  the  skin  it  is  at  once  evaporated,  con- 
stituting what  is  known  as  insensible  perspiration,  amounting  to  one 
or  one  and  one-half  ounces  per  hour.  Under  certain  conditions, 
however,  as  exposure  to  external  warmth,  exertion,  nervous  im- 
pressions, and  in  some  diseases,  the  secretion  increases  rapidly,  col- 
lects in  the  form  of  drops  on  the  external  surface,  is  then  known  as 


Plate    10 — Microscopic    Section   of    Skin,   Showing   Sebaceous    Glands. 


Plate  11 — Microscopic  Section  of  Skin,  Showing  Glandular  Structures. 


ANATOMY  AND  PHYSIOLOGY  OF  THE  SKIN.         17 

sensible  perspiration,  and  may  amount  to  as  much  as  thirty  to  fifty 
ounces  per  hour.  The  most  active  secretory  portions  of  the  body 
are  the  palms  of  the  hand,  the  cheek,  forehead,  soles  of  the  feet, 
breasts  and  upper  arm.  Perspiration  is  favored  by  the  agencies  men- 
tioned  above,  and  also  by  the  free  drinking  of  fluids,  especially  water; 
external  applications  of  alcohol  diminish  the  quantity.  Sweat  is  al- 
kaline in  reaction,  but  becomes  acid,  owing  to  the  admixture  of  fatty 
acids  and  decomposing  sebum.  The  quantity  secreted  has  something 
to  do  with  its  reaction ;  the  more  profuse  the  perspiration  the  nearer 
does  it  reach  a  neutral  reaction.  It  has  a  salty  taste,  a  peculiar  and 
characteristic  odor,  due  to  the  presence  of  sebum  in  the  sweat.  The 
fatty  acids  found  in  the  sweat,  and  influencing  its  reaction  and  odor, 
are  palmitin,  stearin,  formic,  acetic  and  butyric  acids.  Urea  is  also 
present  in  very  small  quantities.  The  function  of  this  secretion  is 
of  great  importance  to  health ;  a  proper  maintenance  of  its  activity  a 
sine  qua  non.  The  extensive  glandular  structures  associated  with 
this  function  permit  of  an  enormous  discharge.  Anatomists  have 
called  attention  to  the  close  resemblance  in  the  anatomical  structure 
of  the  skin  and  kidney,  pointing  out  the  resemblance  of  the  glomeruli 
to  the  coiled  sweat  glands,  while  chemists  have  noted  the  resemblance 
of  perspiration  and  the  urine.  Bouchard  has  shown  it  to  contain  a 
powerful  toxin,  capable  of  lowering  body  temperature.  It  is  a  com- 
mon and  daily  observation  with  clinical  hydriatists  that  there  is  an 
intimate  and  close  relation  between  the  skin  and  the  kidney,  and  that 
the  former  may  become  an  important  aid  to  the  action  of  the  latter. 
In  pathological  states  the  action  of  the  skin  is  usually  increased,  a 
safety  valve  in  those  conditions  in  which  the  integrity  of  the  kidney 
is  threatened.  The  nervous  system  influences  the  secretion  of  sweat 
through  the  action  of  special  secretory  nerves  accompanying  vaso- 
dilators, the  resultant  of  whose  action  is  a  red  and  congested  skin 
followed  by  free  action  of  the  glands. 

Adamkiewicz  states  that  the  dominating  sweat  center  is  located 
in  the  medulla  oblongata.  The  epithelium  lining  the  sweat  glands 
after  free  perspiration  becomes  granular  and  the  nucleus  more  cen- 
tral  (Renaut). 

Healthful  activity  of  the  skin  is  a  condition  most  essential  to 
physical  well-being.  The  state  of  inactivity  of  this  organ,  found 
present  in  nearly  all  chronic  maladies,  is  not  only  a  consequence,  but  a 
cause  of  a  large  number  of  serious  morbid  conditions  of  the  body. 
It  is  in  a  great  majority  of  cases  quite  impossible  to  effect  a  cure 
until  the  skin  has,  by  patient,  persevering  treatment  and  training, 
been  brought  into  a  healthy  state.  The  dry,  sallow,  dingy  skin  is  due 
to  the  accumulation  of  effete  matters  in  it,  and  to  its  impaired  nu- 
trition. 

The  excretion  of  sebaceous  matter  keeps  the  skin  supple  and  pre- 


18  PRACTICAL  HYDROTHERAPY. 

vents  the  hair  from  becoming  too  dry.  It  is  slowly  discharged  from 
the  excretory  ducts  of  the  sebaceous  glands,  and  is  composed  mostly 
of  fatty  granules,  a  few  gland  cells  and  crystals  of  cholesterin.  This 
excretion  gives  the  perspiration  its  characteristic  odor.  The  skin 
possesses  respiratory  functions.  Roehrig  believes  that  carbon  di- 
oxide and  water  are  excreted  from  the  capillary  vessels  in  varying 
proportions,  the  exchange  of  gases  depending  largely  upon  the  vas- 
cularity of  the  skin.  It  is  a  well-known  fact  that  total  suppression  of 
cutaneous   activity   will   cause   death. 

4.  The  Skin  as  a  Vascular  Organ. — An  anatomical  consideration 
of  the  skin  shows  it  to  be  one  of  the  most  richly  supplied  of  the  or- 
gans with  small  blood-vessels,  especially  capillary  ones,  and  it  can 
be  readily  appreciated  that  any  agent  that  will  influence  or  change 
the  blood  stream  from  without  to  within,  or  vice  versa,  is  an  agent 
capable  of  exercising  a  profound  influence  both  in  health  and  dis- 
ease. The  small  arteries  and  capillaries  of  the  skin  are  elastic; 
consist  of  a  single  layer  of  transparent,  excessively  thin,  nucleated 
endothelial  cells  joined  to  each  other  by  their  margins,  and  possessing 
the  power  of  contraction  and  expansion.  The  small  arteries  and  cap- 
illaries are  nothing  more  or  less  than  the  terminal  branches  of  the 
heart,  and  it  is  through  these  that  the  systemic  circulation  takes  place. 
The  great  vascularity  of  the  skeletal  muscles  and  their  close  relation 
to  the  skin,  aid  materially  in  stimulating  normal  activity  of  the  cir- 
culating stream  through  the  cutaneous  surface.  The  skin  responds 
with  promptness  to  any  stimulant  of  a  circulatory  character,  and 
particularly  those  influencing  its  nerve  supply  governing  the  diam- 
eter of  its  blood-vessels.  The  intimate  relation  between  cardiac  ac- 
tivity, blood  pressure  and  vascular  activity  in  the  skin,  is  a  matter 
that  will  be  more  extensively  dwelt  upon  when  we  come  to  consider 
the  action  of  water  upon  the  circulation.  It  may  be  stated,  however, 
that  the  muscular  and  cutaneous  surfaces  are  capable  of  controlling 
and  holding  approximately  60  per  cent,  of  the  entire  blood  of  the  body. 
Hydrotherapeutic  applications  influence  extensively  the  vascularity  of 
the  skin,  and  also  the  action  of  the  heart  and  pulse. 

5.  The  Skin  as  an  Organ  for  the  Regulation  of  Heat. — The  origin 
of  heat  in  the  human  body  is  to  be  sought  for  in  the  food  ingested, 
principally  those  of  non-nitrogenous  bodies,  oxidized  within  the  body, 
mostly  in  muscular  structures.  The  method  of  its  production  is  that 
of  disassimilation  or  destruction,  in  which  oxygen  is  the  oxidizing 
agent.  Its  production  takes  place  in  nearly  all  the  processes  that 
are  necessary  to  the  maintenance  of  health.  Function  is  accompanied 
with  more  or  less  development  of  heat,  the  amount  generated  being 
related  to  the  functional  activity  of  an  organ.  Healthy,  strong,  robust 
persons  generate  more  heat  than  delicate  ones;  more  while  actively 
exercising  than  when  passive. 


ANATOMY  AND  PHYSIOLOGY  OF  THE  SKIN.         19 

The  body  temperature  is  nearly  constant,  although  it  may  be  sub- 
jected to  great  external  variations.  Temperature  impressions  are 
conveyed  over  thermic  nerves  to  centers  located  in  the  brain  and 
spinal  cord,  which  are  in  close  and  intimate  relation  with  the  vaso- 
motor centers  and  those  of  the  abdominal  splanchnic  nerve.  These 
thermic  impressions  bring  the  blood  to  the  surface,  thus  enabling  the 
surplus  heat  of  the  internal  viscera  to  be  dissipated  and  lost  by  evap- 
oration, conduction  and  radiation.  The  internal  temperature  is  con- 
siderably higher  than  that  of  the  surface,  the  equipoise  of  heat  pro- 
duction and  heat  elimination  being  maintained  by  the  skin.  When 
the  skin  is  brought  in  contact  with  a  lower  temperature,  there  is  a 
contraction  of  the  peripheral  vessels,  which,  if  the  extent  is  sufficient, 
causes  involuntary  muscular  movements.  At  the  same  time  there  is 
an  active  dilatation  of  the  blood-vessels  in  adjacent  parts,  to  prevent 
further  entrance  to  cold.  Reflexly,  the  heart  action  is  strengthened, 
driving  more  rapidly  the  current  of  blood  through  the  cutaneous  sur- 
face and  muscular  structures  underlying  it.  The  musculature  of 
the  skin,  reacting  to  cold,  contracts  and  produces  cutis  anserina,  or 
"goose  skin."  The  thermic  stimulation  arouses  the  automatic  cen- 
ters located  within  the  spinal  cord  and  brain  to  increased  production 
of  heat,  through  stimulation  or  paresis  of  the  inhibitory  fibers.  Per- 
spiration is  checked,  evaporation  prevented,  heat  retained,  the  skin 
becoming  pale  and  the  epithelium  more  dry. 

The  exposure  of  the  body  to  a  higher  external  temperature  influ- 
ences the  thermic  nerve  terminations  in  the  skin,  lessening,  through  the 
inhibitory  centers  in  the  spinal  cord  and  brain,  the  production  of  heat. 
At  the  same  time  impressions  are  conveyed  to  the  automatic  centers 
of  the  vaso-motor  system,  which  results  in  the  dilatation  of  the  im- 
mense vascular  area  in  the  skin,  accompanied  by  the  contraction  of 
the  blood-vessels  of  the  internal  viscera.  The  superheated  blood  is 
thrown  to  the  surface,  the  production  of  heat  in  the  internal  viscera 
lessened,  and  functional  activity  of  these  organs  limited. 

Perspiration  breaks  out  closely  related  to  the  amount  of  thermic 
irritation,  and  the  perspiration,  evaporation  and  heat  radiation  coun- 
teract the  unusual  thermic  excitement  upon  the  surface.  If  the  irri- 
tant is  carried  too  far,  a  paresis  of  the  blood-vessels  of  the  skin  takes 
place,  and  a  congested  state  is  the  result.  Owing  to  the  slow  circula- 
tion through  the  internal  organs,  less  heat  is  produced,  and  the  body 
protected  against  overheating.  The  heart's  action  is  accelerated ;  the 
stream  of  blood  is  more  rapidly  and  frequently  brought  from  center 
to  periphery,  is  thus  cooled  and  recooled ;  not  only  is  the  circulating 
medium  more  frequently  passing  through  the  blood-vessels,  but  their 
dilated  condition  is  favorable  for  rapid  and  prompt  loss  of  heat. 

Kellogg1  says :  "The  surface  over  which  the  blood  is  spread  is  not 

1   Kellogg,  J.  H. :  "Rational  Hydrotherapy,"  1907,  p.  84. 


20  PRACTICAL  HYDROTHERAPY. 

fully  represented  by  the  seventeen  square  feet  of  skin  surface,  but 
rather  by  the  11,000  square  feet  of  surface  over  which  the  capillaries 
are  spread  in  the  walls  of  the  perspiratory  tubules — six  times  the 
surface  presented  by  the  lungs."  Respiration  is  more  rapid,  and  heat 
loss  favored  by  evaporation,  from  the  large  area  presented  by  the 
pulmonary  mucous  membrane. 

It  will  be  noted  that  in  the  conservation  of  heat  and  its  dissipa- 
tion, the  mechanism  governing  both  is  reciprocal,  production  and  loss 
being  the  result  of  nervous  action,  maintaining  an  equilibrium  by  vari- 
ations in  the  vascularity,  secretion  and  functionation  of  the  skin. 


CHAPTER   III. 

PHYSIOLOGICAL  ACTION  OF  WATER  EXTERNALLY 
APPLIED. 

The  skin,  anatomically  and  physiologically,  is  capable  of  standing 
abnormal  changes  and  strains  placed  upon  it.  In  order  to  appreciate 
fully  the  physiological  action  of  hydrotherapeutic  applications,  it 
will  be  necessary  to  consider  somewhat  in  detail  the  action  of  heat 
and  cold  upon  the  various  functions  directly  resident  in  the  skin  itself, 
as  well  as  effects  upon  distant  organs,  tissues  and  functions,  the  re- 
sult of  nervous  or  reflex  action.  These  are  brought  about  through 
the  perturbation  of  the  sensory  nerve  endings  in  the  skin  by  thermic 
and  mechanical  stimuli,  are  conveyed  to  the  central  and  sympathetic 
nervous  systems,  impressions  that  start  in  actions  myriad  minute 
responses  within  the  nervous  system  itself  as  well  as  the  body  struc- 
tures and  functions.  The  sensory  nerves  thus  become  the  hydriatist's 
medium  of  excitation. 

Hydrotherapeutic  applications  may  be  used  to  influence  and  affect : 

1.  Temperature. 

2.  Circulation. 

3.  Respiration. 

4.  Metabolism. 

5.  Nervous  system. 

6.  Muscular  system. 

7.  Blood. 

In  addition  to  which  we  must  consider: 

8.  Hydrotherapeutic  reaction. 

9.  Contraindications. 

Taking  a  normal  or  "neutral"  line,  the  temperature  of  which 
ranges  between  92°  and  96°  F.,  temperature  effects  are  produced  as 
we  rise  above  or  fall  below  this  level,  and  it  serves  as  a  central  or 
median  place  from  which  to  classify  baths  or  hydriatic  applications. 
This  neutral  or  normal  temperature  is  so  called  because  it  does  not 
disturb  or  perturbate  the  sensory  nervous  system,  but  shuts  out  all 
impressions,  and  by  its  negativeness  calms  the  peripheral  as  well  as 
the  central  nervous  systems. 

Starting,  then,  with  the  neutral  or  normal  line,  we  base  our  classi- 
fication according  to  temperature,  which  of  necessity  requires  some 
latitude,  and  is  more  or  less  arbitrary  and  artificial. 
(21) 


22  PRACTICAL  HYDROTHERAPY. 

Very  cold    34  deg.  to  55  deg. 

Cold    55     "  "  65  " 

Cool    65     "  "  80  " 

Tepid    80     "  "  92  " 

Neutral,   normal,    line 92     "  "  96  " 

Warm    96     "  "  98  " 

Hot    98     "  "  104  " 

Very  hot   104  and  above. 

"Man  owes  his  relative  constancy  of  temperature  to  great  appa- 
rati  of  clothing,  habitation,  artificial  heat  by  fires,  stoves  and  volun- 
tary movements,  and  the  necessity  for  placing  at  the  head  of  the  list 
of  all  conditions  subservient  to  the  maintenance  of  life  is  that  of 
warmth,  which  is  even  more  important  to  be  attended  to  than  nourish- 
ment itself."  (Samuel.)  "No  matter  how  manifold  the  measures  may 
be  which  the  nature  of  the  more  highly  organized  animals  has  endowed 
them  with,  in  order  to  enable  them  to  maintain  the  heat  of  their  own 
interiors  against  the  changes  of  external  temperatures,  and  no  matter 
how  well  they  may  understand  by  their  instinct  to  support  these 
measures,  yet  they  only  fulfill  the  requirements  put  to  them  within 
the  very  narrow  limits  of  the  most  favorable  conditions.  Beyond 
these,  as  a  matter  of  fact,  the  native  heat  to  warm-blooded  animals 
is  wanting  in  that  renowned  stability  which  one  has  been  in  the  habit 
of  considering  to  be  one  of  the  most  marvelous  facts  in  nature. 
When  we  are  in  our  clothing  we  are  in  the  same  condition  we  should 
be  in  if  we  were  naked  in  a  specific  atmosphere  at  the  temperature 
of  from  24°  to  30°  C.  (75.2  to  86°  F.).  The  temperature  of  separate 
climatic  regions  between  the  skin  and  clothes,  therefore,  is  a  much 
more  constant  one  than  we  might  at  first  glance  suppose,  judging  by 
the  great  difference  of  temperature  between  the  blood,  and  compen- 
sated by  fresh  waves  of  arterial  blood,  connected  to  the  part  to  which 
cold  is  applied,  and  the  converse  is  true  in  extreme  applications  of 
heat."  And  that  "the  amount  of  temperature  reduction  depends  more 
upon  the  intensity  of  the  thermic  irritation  of  the  cutaneous  sensory 
nerves  than  any  other  element,"  has  been  pointed  out  by  Winternitz. 

That  the  application  of  varying  temperatures  has  its  influence  upon 
organic  life,  is  well  known  to  all  physiologists,  and  is  capable  of  easy 
demonstration.  Most  of  us  have  observed  under  the  microscope  the 
slowing  of  the  cilia  of  epithelium  under  cold,  its  stimulation  by  mod- 
erate temperatures  of  heat,  and  its  suspension  of  movements  by  both 
extremes.  A  full  knowledge  of  these  responses,  independent  of  me- 
chanical stimulation,  enables  the  hydrotherapeutist  to  play  upon  the 
skin  in  a  marvelous  manner.  That  cold  diminishes  vital  activity,  and 
that  heat  enhances  it,  is  a  daily  observation.  The  essential  effects 
of  heat  and  cold  upon  the  organism  in  health  are  practically  the  same 
when  applied  to  pathological  conditions,  and  its  ability  to  produce 
normal  responses  in  diseased  tissues  results  in  restoring  to  them  their 


PHYSIOLOGICAL  ACTION  OF  WATER.  23 

lost  equilibrium.  Great  latitude  exists  in  different  persons  with  re- 
gard to  the  appreciation  of  heat  and  cold.  These  impressions  vary 
considerably  in  different  parts  of  the  body,  and  are  influenced  by  the 
nervous  condition,  circulatory  processes,  and  reactive  capacity  of  the 
individual. 

Physiological  Action  Upon  Temperature. 

The  normal  temperature  of  the  human  body  is  usually  98.6°  F., 
but  it  may  rise  .5°  in  the  mouth — to  99.1°  F.  Increased  temperature 
may  be  induced  physiologically  by  exercise,  mechanical  stimulation, 
thermic  irritation,  and  may  be  augmented  (or  decreased)  by  many 
pathological  states.  Where  thermic  irritation  causes  a  rise  in  tem- 
perature, this  is  brought  about  reflexly  from  irritation  of  the  sensory 
nerves  of  the  surface,  carrying  impressions  and  acting  upon  thermo- 
genetic  centers  located  in  the  medulla,  governing  automatic  centers 
located  in  the  spinal  cord,  these  in  turn  having  control  of  those  tissues 
mostly  concerned  in  the  production  of  heat,  that  is,  the  muscles. 
These  medullary  centers  may  increase  or  decrease  or  inhibit  the 
lower  automatic  centers.  But  reflex  action  is  not  the  only  way  in 
which  the  nervous  system  is  stimulated  to  regulate  heat  generation 
and  loss.  The  surface  blood,  absorbing  or  losing  heat,  as  the  case 
may  be,  bathes  the  neurons  in  a  blood  of  higher  or  lower  temperature, 
as  a  result  of  which  they  respond.  Increased  bodily  temperature 
may  result  from  several  conditions — (a)  increased  heat  production, 
(b)  decreased  heat  elimination,  and  (c)  a  combination  of  the  two, 
both  increased  production  and  decreased  elimination.  This  in  hydri- 
atics  may  be  accomplished  even  by  a  warm  bath  of  a  few  degrees  of 
temperature  above  the  body,  or  warm  or  hot  air  of  varying  tempera- 
tures. These  produce  their  effects  by  preventing  heat  elimination 
from  the  skin,  by  conducting  heat  into  and  through  the  skin  to  the 
tissues  below,  thereby  raising  their  temperature.  The  mere  pres- 
ence of  heat  stimulates  vital  activity  and  at  the  same  time  increases 
bodily  production.  Temperature  is  quickly  raised  by  baths  at  105°  F. 
and  over,  Kellogg1  having  shown  that  there  is  a  rise  of  1°  F.  in  bodily 
temperature  for  every  20°  F.  in  the  surrounding  media.  When  the 
bodily  temperature  rises,  the  natural  forces  are  aroused  to  meet  the 
changed  conditions,  in  an  endeavor  to  eliminate  heat.  The  intimate 
relation  of  the  thermic  centers  with  the  vasomotors  enables  this  to 
be  done  through  their  action  upon  the  vascular  system,  by  dilating 
the  superficial  blood-vessels  and  carrying  more  blood  to  the  surface 
to  be  cooled ;  by  contracting  the  visceral  blood-vessels,  lessening  func- 
tion and  heat  production ;  by  accelerating  the  heart  action  so  that 
the  blood  is  more  frequently  passed  through  the  superficial  blood- 
vessels ;   by   increasing   the   respiration   so   that   the   blood   is   oftener 

1   Kellogg,  J.  H.:   "Rational  Hydrotherapy,"  1906,  p.   159. 


24  PRACTICAL  HYDROTHERAPY. 

cooled ;  by  perspiration,  in  which  heat  is  lost  through  conduction, 
radiation  and  evaporation,  the  last  a  distinct  cooling  method.  It  is 
eminently  a  blood  vascular  process. 

Decreased  bodily  temperature  may  result  from  (a)  decreased  heat 
production,  i  b  |  increased  heat  elimination,  and  |  c )  a  combination 
of  both,  diminished  production  and  increased  elimination.  This  de- 
creased state  cannot  in  hydriatics  be  produced  by  brief  cold  appli- 
cations, reaction  occurring  and  preventing  the  loss  by  all  those  changes 
incident  to  it.  Short,  brief  methods  reflexly  stimulate  the  thermo- 
genetic  centers  which  accelerate  the  production  of  heat,  especially  in 
the  interior,  as  well  as  in  the  thermogenetic  tissues  of  the  body,  the 
muscles.  This  increased  formation  is  retained  in  the  body,  owing 
to  the  contracted  skin.  Heat  loss  is  lessened  by  the  slowed  heart 
action  sending  less  blood  to  the  surface ;  by  checking  perspiration  and 
contracting  the  blood-vessels  less  blood  is  exposed ;  by  diminished 
respiration,  so  that  little  evaporation  occurs  and  less  air  needs  heating. 

The  Physiological  Action  of  Heat  on  Temperature. 

The  temperature  at  which  water  is  recognized  as  being  warm  or 
hot  commences  at  about  98°  F.,  and  ranges  between  this  figure  and 
104°  to  105°  F.,  above  which  point  all  temperatures  are  hot.  Tem- 
peratures of  120°  in  general  applications  are  endured  by  some  few 
persons,  but  are  borne  with  difficulty  by  the  majority  of  humanity. 

As  soon  as  the  body  is  surrounded  by  a  medium  of  higher  tem- 
perature, the  medium  begins  to  lose  and  the  body  to  acquire  heat  by 
conduction  from  the  medium  into  the  skin  and  tissues  of  the  body. 
Being  submerged  in  water  even  a  few  degrees  higher  than  the  body, 
prevents  the  usual  heat  loss  from  the  skin,  so  that  heat  is  retained  from 
failure  of  the  skin  to  eliminate  it.  The  rise  in  body  temperature  is 
fairly  proportional  to  the  duration  and  temperature  of  the  surround- 
ing medium.  This  rise,  ranging  in  my  own  observation  from  .5°  F.  to 
even  2°  F.,  continues  until  the  vital  forces  respond  and  throw  off  the 
effect. 

As  the  tissues  heat  up  and  the  surface  temperature  rises,  the 
blood  absorbs  the  heat,  and  this  current,  now  superheated,  sets  in 
toward  the  thermic  centers  in  the  medulla  and  cord.  These  begin  at 
once  to  respond  in  their  endeavor  to  throw  off  the  irritant,  accom- 
plishing this  result  by  all  those  means  that  bring  about  heat  loss. 
It  may  be  stated  that  in  health  short  applications  make  little  change 
in  the  bodily  temperature.  Temperatures  here  named,  between  98° 
and  120°  P.,  apply  strictly  to  water,  and  not  to  other  media,  for  the 
body  may,  under  proper  conditions,  be  submitted  to  superheated  dry 
hot  air  at  from  300°  to  400°  F.  With  water,  very  much  higher  tem- 
peratures can  be  borne  where  they  are  local.  In  the  application  of 
higher   temperatures,    130°    F.   and   above,   a   transient   pallor   of   the 


PHYSIOLOGICAL  ACTION  OF  WATER.  25 

skin  takes  place,  accompanied  by  contraction  of  the  smooth  muscular 
fibers  of  the  cutis,  producing  a  goose  skin  effect.  The  sudden  impact 
of  very  great  heat  may  produce  tremor  and  shivering.  The  increased 
temperature  within  and  upon  the  skin  results  not  alone  in  activity 
of  the  perspiratory  glands,  but  the  sebaceous  glands  are  aroused  to 
eliminate  as  well.  The  increased  temperature  of  the  body,  it  will 
thus  be  seen,  results  from  heat  conduction  from  the  media  into  the 
tissues,  and  by  the  prevention  of  heat  elimination. 

As  thermic  impressions  rise  above  and  fall  below  the  "neutral'* 
level,  we  find  extremes  meeting,  a  very  hot  and  a  very  cold  applica- 
tion being  interpreted  as  pain.  In  practice  the  hydriatist  takes  ad- 
vantage of  these  temperature  effects  by  first  using  a  warm  or  hot 
application  followed  by  a  cool  or  cold  one.  in  order  that  each  may 
enhance  the  other.  Where  warm  applications  precede,  cold  is  more 
acutely  felt.  When  we  have  increased  sufficiently  the  heat  upon  and 
within  the  skin  and  superficial  tissues,  cold  rarely  depresses,  heat 
abstraction  being  prevented  by  the  increased  vascular,  nervous  and 
vital  activities. 

Physiological  Action  of  Cold  on  Temperature. 

Temperatures  of  water  recognized  as  being  cold  commence  at  92Q 
and  range  between  this  figure  and  34°  F.  Temperatures  of  34°  are 
borne  by  some  few  people,  but  the  majority  cannot,  as  a  rule,  stand 
45°  F.  Very  much  colder  temperatures  can  be  used  in  local  applica- 
tion. The  first  effect  of  an  application  of  cold  water  to  the  skin  is 
a  refrigeration,  pallor  and  chilliness  of  the  surface,  accompanied  by 
a  contraction  of  the  superficial  small  blood-vessels. 

Coincident  with  the  contraction  of  the  capillaries,  the  influx  of 
blood  into  the  skin  is  checked,  through  impressions  made  upon  the 
sensory  nerves  and  reflected  along  the  vasoconstrictors.  When  con- 
traction of  the  small  vessels  takes  place,  the  circulation  is  decidedly 
diminished,  less  opportunity  is  afforded  for  the  elimination  of  heat 
from  the  skin,  while  reflex  action  stimulates  and  increases  the  devel- 
opment and  production  of  heat  within  the  body. 

It  may  be  repeated  that  in  healthy  individuals  taking  an  ordinary 
cold  bath  or  hydriatic  application,  the  heat  loss  is  not  demonstrable 
by  the  thermometer ;  if  the  bath  is  moderately  long,  and  not  very  cold, 
the  bodily  temperature  will  remain  constant,  the  balance  between  the 
heat  loss  and  heat  production  being  maintained  by  natural  activities. 

Cold  is  essentially  a  depressant  in  its  primary  effect,  but  the  forces 
of  the  body  at  once  respond  to  prevent  baleful  influences  and  to  resist 
its  effects,  both  by  the  prevention  of  heat  elimination  and  by  in- 
creased heat  production.  There  is  a  popular  notion  prevalent  among 
the  profession  and  laity  that  it  is  dangerous  to  apply  cold  to  healthy 
persons   while   perspiring    freely,    for    fear   of   reducing   temperature. 


26  PRACTICAL  HYDROTHERAPY. 

It  is  the  experience  of  hydriatists  that  no  harm,  but  good,  results 
from  such  applications,  provided  the  person  is  not  at  the  time  over- 
fatigued.  The  writer  has  frequently  observed  young  men  for  this 
reason  refusing  to  enter  the  water  or  swim  until  they  have  "cooled 
off."  The  application  of  cold  water  to  the  external  surface  may  be 
used  to  lower  internal  as  well  as  surface  temperature.  This  loss  is 
facilitated  by  the  administration  of  friction,  a  fact  utilized  by  Brand 
in  his  bath  for  the  treatment  of  typhoid  fever.  Friction  causes  a  dila- 
tation of  the  surface  blood-vessels  through  its  action  upon  the  vaso- 
motor system.  The  dilated  blood-vessels  bring  to  the  surface  a  larger 
volume  of  blood,  favoring  greater  heat  loss.  Heat  elimination  is 
much  more  pronounced  in  febrile  conditions  than  under  normal  and 
physiological  ones.  Winternitz  has  shown  that  heat  elimination  can 
be  increased  by  friction  30  per  cent.,  and  that  its  application  during 
the  cold  bath  will  prevent  collapse.  In  febrile  conditions  the  super- 
heated blood,  brought  to  the  surface  by  the  friction,  and  in  contact 
with  the  cold  water,  gives  up  its  heat  and  re-enters  the  circulation 
considerably  cooler.  This  has  a  direct  effect  upon  the  heat  centers, 
especially  the  thermogenetic  one,  lessening  the  formation  and  favor- 
ing elimination.  The  intimate  relation  between  the  heat  centers  and 
the  vasomotors  enables  the  refreshed  centers,  struggling  under  febrile 
toxins,  to  better  stimulate  this  center  to  dilate  its  peripheral  blood- 
vessels and  cause  further  heat  loss.  Here  and  elsewhere  it  must, 
however,  be  noted  and  never  forgotten,  that  the  use  of  cool  or  cold 
water  in  febrile  states  is  not,  as  so  firmly  believed,  to  simply  reduce 
temperature.  While  this  does  take  place,  still  the  important  ele- 
ment is  the  rousing  of  the  nervous  system  to  battle  against  the  in- 
vading host.  This  will  be  more  clearly  shown  when  we  consider 
typhoid  fever.  Localized  applications  reduce  the  temperature  of  the 
part  to  which  the  cold  is  applied,  but  have  no  appreciable  systemic 
effect.  In  some  instances,  continuous  applications  of  cold  to  the  head 
reduce  general  temperature  by  acting  upon  the  heat  centers  of  the 
brain,  just  as  an  ice  bag,  when  applied  over  the  heart,  may  produce 
the  same  effect,  by  cooling  the  blood  and  slowing  the  heart's  action. 

Physiological  Action  Upon  the  Circulation. 

The  circulatory  system,  comprising  the  heart  and  blood-vessels, 
may,  from  a  general  point  of  view,  be  divided  into  four  divisions: 
(1)  The  heart,  acting  as  the  propelling  organ,  or  the  vis  a  tcrgo,  to 
the  movement  of  the  blood,  distributing  it  to  the  different  areas  of 
the  body,  principally  under  the  influence  of  the  vasomotor  system 
of  nerves.  These,  in  their  turn,  are  influenced  by  all  conditions 
within  and  without  the  economy — heat,  cold,  functional  activity, 
emotions,  nervous  actions  of  various  sorts,  etc.  (2)  The  arterial  system, 
with  three  great  areas  that  are  of  extreme  interest  to  the  hydriatist — 


PHYSIOLOGICAL  ACTION  OF  WATER.  27 

the  arteries  of  the  >kin.  the  arteries  of  the  muscles,  and  those  of  the 
internal  viscera,  especially  those  supplied  by  the  splanchnic  nerves 
and  commonly  influencing  portal  circulation.  (3)  Capillaries,  those 
minute    intermediate    blood-vessels    between    the    arteries    and    veins. 

(4  )    The  veins. 

All  of  these  are  influenced  directly  and  indirectly  by  the  appli- 
cation of  varying  temperatures  to  the  external  surface,  especially  the 
skin  and  muscular  system.  The  quantity  of  blood  in  the  human 
body  is,  within  reasonable  limits,  fixed,  and,  ex  necessitate  rci,  the 
production  of  an  influx  of  blood  into  any  one  of  the  great  physio- 
logical areas  of  the  body  (  skin,  muscles,  viscera)  acts  as  a  depletent 
upon  the  others,  and  is  a  ready  explanation  of  why  a  person  may 
feel  faint  when  suddenly  entering  into  a  hot  room,  or  while  taking 
treatment  in  a  hot  air  or  vapor  bath. 

The  Action  of  Heat  Upon  the  Circulation. 

Placed  in  a  warm  or  hot  bath,  or,  for  better  illustration,  in  a  hot 
air  chamber  or  other  heating  method,  the  primary  or  immediate  effect 
will  be  the  sensation  of  heat.  This  is  conveyed  centrally  by  the  sen- 
sory nerves,  and  produces  a  temporary  or  transient  slowing  of  the 
pulse  and  heart's  action,  with  an  increased  force  of  the  former. 
Coincident  with  this,  there  may  be  noticed  slight  oppression  of  breath- 
ing, tightness  and  throbbing  in  the  head,  or  faintness.  The  skin  and, 
later,  by  conduction,  the  subcutaneous  structures,  begin  to  absorb 
heat  from  the  surrounding  warm  medium,  accompanied  by  the  distinct 
sensation  of  increased  surface  warmth  to  the  examining  hand.  After 
a  variable  time,  by  conduction,  absorption  and  action  upon  the  cu- 
taneous thermic  nerves,  the  superficial  blood-vessels  dilate  and  the 
skin  assumes  a  more  pinkish  hue,  due  to  the  increased  amount  of 
blood  on  the  surface.  The  heart*s  action  is  noticeably  increased,  the 
pulse  more  rapid  and  smaller,  and  arterial  tension  lowered.  The 
larger  amount  of  blood  upon  the  surface  absorbs  the  heat  that  has 
entered  the  tissues,  and,  re-entering  the  general  circulation,  is  carried 
to  the  medullary  centers  governing  heat  formation  and  dissipation, 
and  which  are  in  intimate  association  with  the  vasomotor,  cardiac  and 
respiratory  centers.  This  heated  blood  quickens  the  response  of  the 
centers  and  causes  the  necessary  changes  to  take  place  on  the  surface 
that  will  insure  heat  loss,  the  natural  forces  responding  to  the  thermic 
stimuli  in  their  endeavor  to  throw  off  or  offset  the  effects,  by  heat  loss 
from  the  dilated  vascular  surface,  and  by  perspiration.  The  latter  aids 
by  the  heat  it  removes  and  by  evaporation — a  distinctly  cooling  process. 
As  we  have  seen,  the  temperature  of  the  tissues  is  raised.  If,  instead  of 
heated  air,  we  employ  water,  the  results  are  the  same,  save  that,  where 
mechanical  stimulation,  as  in  the  douches,  is  superadded,  the  action  is 
more  rapid  and  pronounced.     As  soon  as  the  surface  dilatation  takes 


28  PRACTICAL  HYDROTHERAPY. 

place,  and  the  stream  of  blood  is  directed  outward,  the  blood-vessels 
of  the  internal  organs,  because  of  the  lessened  amount  of  blood,  and 
by  reflex  action,  contract,  thus  bringing  about  a  physiological  anemia. 
Where  heat  is  long  continued,  an  atonic  vascular  state  is  induced, 
accompanied  by  more  or  less   relaxation  and   enervation. 

Extreme  heat  or  hot  water  applied  to  limited  areas  produces  tem- 
porarily the  same  effects  as  extreme  cold — local  tissue  and  superficial 
blood  vascular  contraction,  general  rigor  and  the  sensation  of  pain. 
A  practical  point  in  relation  to  the  contraction  of  the  internal  blood- 
vessels of  the  brain  is  the  use  of  cold  to  the  head.  This  will  main- 
tain vascular  tone  and  prevent  cerebral  symptoms,  faintness,  oppres- 
sion, etc. 

The  Action  of  Cold  Upon  the  Circulation. 

The  influence  of  cold  upon  the  cutaneous  surface  is  more  decisive 
than  that  of  heat,  and,  as  has  before  been  stated,  is  tonic  in  its  action. 
This  rapidity  of  action  on  the  part  of  cold  is  one  of  its  most  inter- 
esting effects.  Immediately  following  a  general  cold  application,  we 
find  a  refrigeration  takes  place,  accompanied  by  pallor  and  contrac- 
tion. These  changes  are  easily  detected  by  touch  and  inspection. 
The  skin  becomes  pale,  somewhat  shrunken,  and  the  superficial  blood- 
vessels contracted.  The  thermic  nerves  conveying  the  cutaneous  im- 
pression of  cold  to  the  central  nervous  and  sympathetic  systems, 
transiently  increase  heart  action  and  pulse  rate,  but  where  the  appli- 
cation is  brief — that  is,  tonic — it  is  almost  immediately  succeeded  by 
a  lessened  frequency  and  stronger  heart  beat.  The  pulse  is  slowed 
and  its  volume  notably  increased,  a  fact  easily  demonstrable  to  the 
finger.  Concomitantly  the  blood  pressure  rises,  sometimes  from  20 
to  40  m.m.,  as  revealed  by  the  Riva-Rocci  sphygmanometer  (broad 
band).  My  personal  tests  have  shown  that  the  peripheral  tonic  in- 
crease of  circulation  is  due  to  the  better  blood  pressure,  and  not  to 
a  weakened  vascular  state.  Winternitz,  Strasser,  Baruch  and  Kellogg2 
have  made  like  observations,  especially  the  latter.  These  results,  physi- 
ologists tell  us.  arise  from  reflex  action,  which  temporarily  excites 
the  accelerator  nerves  of  the  heart,  later  slowing  its  action  through 
the  pneumogastric.  With  the  cessation  of  the  application  and  reac- 
tion, the  blood-vessels  become  slightly  dilated,  and  more  blood  actu- 
ally circulates  through  the  skin.  This  dilatation  of  the  blood-vessels 
is  tonic ;  that  is  to  say,  there  is  a  moderate  contraction  of  the  vessel 
walls,  the  result  of  the  action  of  the  inhibitory  fibers  and  centers 
upon  the  vasomotors.  The  vasomotor  mechanism  of  the  body  is 
most  intimately  concerned  with  the  production  of  all  these  vascular 
changes,  both  in  its  periphery  and  centers  located  in  spine  and  me- 

2  Kellogg.  J.  H. :  "Rational  Hydrotherapy,"  1906:  Baruch,  Simon,  "Hydrotherapy," 
1899;  Winternitz,  Wm,  "Die  Hydrotherapie  auf  physiolegisclier  und  klinisehcr  Grundlage,"" 
1890. 


PHYSIOLOGICAL  ACTION  OF  WATER.  29 

dulla  oblongata.  These  nerves  run  in  the  mixed  spinal  nerves,  and 
are  closely  associated  with  the  different  sensations  that  arise  normally 
at  the  periphery  and  usually  recognized  by  afferent  nerves.  Again, 
we  note  that  where  the  circulation  is  actively  drained  into  a  part 
there  is  a  lessening  of  the  quantity  of  blood  in  some  other  vascular 
region.  This  fact  is  utilized  in  practice,  especially  with  reference 
to  the  action  upon  the  abdominal  blood-vessels  supplied  by  the  splanch- 
nic nerves,  the  dilatation  of  these  blood-vessels  producing  vascular 
anemia  in  distant  parts,  or  vice  versa.  These  results  are  more  quickly 
induced,  lower  temperatures  better  borne,  and  the  effect  longer  con- 
tinued and  more  extended,  where  accompanied  by  mechanical  stimu- 
lation, as  in  the  various  forms  of  douches. 

That  the  physiological  action  of  external  temperatures,  applied 
to  the  skin  and  acting  upon  distant  blood-vessels,  is  more  particularly 
brought  about  through  reflex  action  than  by  any  other  means,  has  been 
clearly  demonstrated  by  Naumann  in  the  following  experiment : 

The  head  of  a  frog  was  separated  from  the  body,  being  only  con- 
nected by  the  medulla  oblongata.  He  next  severed  one  leg,  after  pre- 
venting the  loss  of  blood  by  tying  the  vessels  so  as  to  leave  it  con- 
nected with  the  body  by  the  sciatic  nerve.  He  now  applied  thermal, 
chemical  and  electrical  stimuli  to  the  foot  of  the  partially  severed  leg, 
while  he  observed  under  the  microscope  the  mesentery.  Shortly  after 
gentle  irritation  of  the  peripheral  endings  of  the  sciatic  nerve  in  the 
foot,  the  circulation  in  the  vascular  network  of  the  lungs  and  mesen- 
tery was  accelerated,  and  resumed  the  former  condition  slowly  after 
the  withdrawal  of  the  irritant.  Strong  irritation  of  the  skin  weakened 
its  circulation ;  the  feeble  irritant  strengthened  it.  As  there  was 
no  possible  vascular  or  nerve  channel  from  the  part  irritated  to  the 
part  thus  visibly  affected,  the  conclusion  is  inevitable  that  the  effect 
was  purely  reflex. 

Maximilian  Schiiler3  trephined  rabbits,  carefully  exposing  to  view 
the  vessels  of  the  pia  mater  without  disturbing  the  dura,  which,  by 
its  transparency,  facilitated  his  observation.  He  carefully  noted  the 
normal  circulation  of  these  vessels,  and  ascertained  that  even  simple 
pressure  upon  the  belly  produced  dilatation  of  the  veins,  and  some- 
times also  of  the  arteries,  probably  through  mechanical  interruption 
of  the  venous  return  flow.  The  most  interesting  observation,  how- 
ever, was  that  when  he  placed  cold  wet  compresses  upon  the  belly  of 
the  rabbit,  the  vessels  of  the  pia  mater  invariably  dilated,  cerebral  pul- 
sation became  more  pronounced  and  slower,  the  respiration  was  deep- 
ened and  slowed.  When  warm  compresses  were  applied  the  arteries 
and  veins  of  the  pia  mater  contracted,  the  pulsation  became  less  pro- 
nounced and  more  frequent,  and  respiration  more  shallow  and  rapid. 


3    Schueler,    Maz:     Deutsches   Archiv.   f.   klinische   Medicin,    No.   4,    1874,   XIV.      Quoted 
by  Baruch. 


30  PRACTICAL  HYDROTHERAPY. 

Indeed,  it  may  be  regarded  as  proved  that  a  causal  connection  cer- 
tainly exists  between  the  various  external  applications  of  water  and 
the  typical  changes  in  the  vessels  of  the  pi  a. 

Schuller  believe?  that  "in  the  beginning  of  the  application  the  pial 
vessels  are  affected  by  reflex  irritation  from  the  cutaneous  nerves, 
and  that  the  real  effect  upon  the  pial  vessels  occurs  only  when  the 
thermic  influence  upon  the  cutaneous  vessels  has  gained  the  ascen- 
dency. Local  applications  of  cold  to  a  limited  area  produce  shrinking 
and  shrivelling  at  the  point  of  contact.  Pallor  accompanies  this  con- 
dition, due  to  a  contraction  of  the  blood-vessels  and  finer  capillaries, 
especially  their  circular  fibers,  by  means  of  which  the  blood  is  driven 
out.  Long  continued,  a  paralysis  and  dilatation  of  the  blood-vessels 
occurs.  It  is  axiomatic  that  prolonged  cold  depresses  circulation  and 
vitality,  short  applications  act  as  a  tonic.  It  is  interesting  to  note,  at 
this  point,  that  the  general  vascular  tone  brought  about  by  the  appli- 
cation of  cold  to  the  surface  more  nearly  resembles  the  healthy  con- 
dition of  blood  vascular  circulation  than  that  induced  by  any  other 
remedial  measure.  The  heart  may  be  slowed,  its  contractions  made 
firmer,  the  pulse  fuller,  dyspnea,  discomfort  and  precordial  distress 
relieved  b)  the  cold  compress,  coil  or  ice-bag  applied  over  the  heart — 
that  is,  to  the  precordium.  Winternitz  has  summed  up  its  effects  and 
action  by  the  apt  name  he  gave  it,  "the  hydrotherapeutic  digitalis." 
The  alternate  application  of  heat  and  cold  to  the  cutaneous  surface 
acts  as  battledoor  and  shuttlecock  with  the  circulation;  heat  dilating 
the  superficial  blood-vessels,  increasing  the  heart's  action,  accelerating 
the  pulse,  lessening  resistance  and  lowering  arterial  tension;  cold 
contracting  (tonically)  the  superficial  blood-vessels,  decreasing  heart 
action,  slowing  the  pulse  and  raising  arterial  tension.  These  circu- 
latory changes,  following  one  another,  influence  the  activity  of  dis- 
tant organs.  Temperature,  nerve  and  vascular  effects  are  closely 
allied,  and,  as  in  heat  production,  so  in  blood  vascular  circulation, 
cold  enhances  the  tone  of  the  blood-vessel  wall,  while  heat  lowers  it, 
although  both  may  be  followed  by  vascular  dilatation,  in  the  one  in- 
stance tonic  (cold),  in  the  other,  atonic  (heat).  It  is  because  of  the 
reflex  action  just  above  noted  that  clinicians  utilize  dermal  thermic  ap- 
plications for  the  production  of  special  changes  in  the  circulation,  and 
by  these  means  endow  the  different  organs  with  increased  and  active 
function.  The  blood  is  the  life  of  the  individual  and  of  the  part ;  it 
is  the  great  road  upon  which  is  conveyed  nutriment  to  each  and  every 
tissue ;  the  highway  upon  which  all  waste  products  are  removed  from 
the  various  organs ;  through  the  blood  repair  and  growth  take  place ; 
it  eliminates  waste  products  and  maintains  health.  It  is  thus  evident 
upon  reflection  that  he  who  controls  in  a  measurable  degree  the  circu- 
lation of  the  human  body  controls  measurably  all  of  its  functions, 
all  of  its  activity,  and  has  within  his  grasp  a  means  alike  of  preventing 


PHYSIOLOGICAL  ACTION  OF  WATER.  31 

disease  and  of  restoring  health.  The  circulation  is  one  of  those  flex- 
ible agents  by  means  of  which,  in  diseased  conditions,  medicaments 
are  carried  to  their  destination  and  function  stimulated.  Thus  any 
agent  that  enhances  or  controls  circulatory  activity  and  distribution, 
influences  and  controls  the  absorption,  distribution,  action  and  activ- 
ity of  any  remedial  medicinal  agent  used.  One  of  the  most  satisfac- 
tory and  valuable  of  all  the  effects  of  thermic  applications  to  the 
periphery,  is  the  fact  that  through  its  influence  upon  the  vasomotor 
system  the  circulation  and  activity  of  far  distant  organs  are  materially 
changed.  Thus,  a  congested  or  inflammatory  condition  of  an  internal 
viscus  may  be  relieved  not  only  by  the  suction-like  process  of  drawing 
blood  to  the  surface,  or  by  the  increased  pressure  of  the  blood  behind 
forcing  it  out  of  the  congested  organ,  but  also  by  the  increase  of  its 
circulatory  activity,  carrying  to  it  restorative  pabulum,  by  means  of 
which  it  may  regain  its  normal  structure  or  may  manufacture  again 
its  normal  secretion. 

Physiological  Action  Upon  Respiration. 

The  main  object  of  the  respiratory  process  is  to  supply  the  system 
with  the  oxygen  necessary  for  oxidative  purposes  within  the  economy. 
Respiratory  function  is  carried  on  through  the  action  of  the  lungs 
and  skin.  The  mechanism  consists  of  the  alternate  dilatation  (inspi- 
ration) and  contraction  (expiration)  of  the  chest  wall,  the  movement 
being  dependent  upon  muscular  structures  attached  to  the  chest  walls, 
together  with  certain  additional  muscular  structures  that  may  be 
brought  into  play  under  unusual  circumstances.  The  average  number  of 
respirations  ranges  from  16  to  18  per  minute,  and  bears  the  ratio 
to  the  pulse  of  one  to  four.  The  inspired  air  converts  the  dark  venous 
blood,  carrying  reduced  hemoglobin  (Hb)  to  bright  arterial  blood 
(HbCX),  the  former  giving  up  its  carbon  dioxide  and  substituting 
in  its  place  oxygen,  held  in  loose  combination.  The  skin  likewise 
loses  C02  and  gains  O  by  diffusion  of  gases.  The  function  of  respi- 
ration is  presided  over  by  a  nervous  mechanism,  and  thermic  im- 
pressions influence  respiration  by  stimuli  reaching  it  through  reflex 
nervous  impulses.  Peripheral  impressions  may  deepen  or  weaken 
respiratory  action.  The  intimate  and  close  relationship,  both  struc- 
turally, by  nerve  connection  and  function,  between  Ihe  cardiac  and 
respiratory  systems,  is  such  that  any  impressions  acting  upon  one  may 
result  in  influencing  both. 

Impulses  are  conveyed  to  the  respiratory  center  in  the  medulla 
through  the  nerves  of  common  sensation  by  way  of  the  spinal  cord, 
are  there  correlated  and  reflected  to  the  agent  directly  concerned  in 
the  respiratory  act,  the  lungs.  The  respiratory  center  may  be  influ- 
enced by  thermic  impressions  applied  to  limited  areas,  as  is  seen  by 


32  PRACTICAL  HYDROTHERAPY. 

the  deep  inspiration  that  takes  place  when  cold  water  is  applied  to  the 
face  of  a  person  who  has  fainted. 

The  Action  of  Heat  Upon  Respiration. 

The  immediate  effect  of  a  sudden  general  or  local  application  of 
heat  or  hot  water  upon  the  respiratory  function  is  a  deep  gasping, 
jerky  and  irregular  inspiration,  lasting  for  a  few  seconds,  accom- 
panied by  a  sense  of  constriction  in  the  chest,  slight  oppression,  and 
succeeded  by  a  well-marked  increase  in  the  number  of  respirations, 
which  are,  however,  much  shallower  in  depth.  This  increase  is  very 
variable,  so  far  as  my  personal  observations  are  concerned.  These 
effects,  primary  in  character,  are  due  solely  to  reflex  action,  resulting 
from  the  thermic  stimuli  upon  the  surface,  but  when  the  individual's 
responsive  power  comes  into  play  they  may  rapidly  diminish.  Another 
factor  is  then  added.  As  the  temperature  of  the  surface  and  surface 
tissues  rises  the  blood  absorbs  heat,  is  conyeyed  to  and  bathes  the 
medullary  center,  and  by  its  irritation  maintains  an  increased  respira- 
tory action,  of,  however,  a  more  steady,  regular  and  equable  character. 
By  the  increased  respiratory  action,  some  heat  and  considerable  vapor 
are  lost.  These  stimuli,  remaining  within  physiological  bounds,  aug- 
ment the  accelerator  action  of  the  center,  but,  where  they  become  too 
powerful,  may  act  as  inhibitory  factors  by  influencing  the  pneumo- 
gastric. 

There  is  very  little  contraction,  and,  after  a  short  period,  consid- 
erable relaxation,  of  all  the  muscular  structures  concerned  in  respi- 
ration— a  characteristic  action  of  heat  upon  these  tissues.  Mechan- 
ical stimulation  accompanying  the  application  may  more  quickly  pro- 
duce these  changes.  The  more  rapid  and  shallower  respiration  is 
not  conducive  to  better  absorption  of  oxygen  and  the  elimination  of 
carbon  dioxide,  but  is,  on  the  contrary,  an  endeavor  on  nature's  part 
to  by  rapidity  make  up  the  necessarily  diminished  intake,  the  result 
of  its  shallowness;  hence  we  find  the  exchange  and  diffusion  of 
gases  lessened.  Should  the  respiration  become  more  adapted  to  the 
changed  and  heated  surroundings,  just  in  proportion  will  the  gaseous 
exchange  be  increased.  My  personal  observation  has  been  that  depth 
of  inspiration  is  the  essential  factor.  It  may  be  said,  in  conclusion, 
that  both  factors  reinforce  one  another,  the  one  reflex,  the  other 
the  bathing  of  the  center  in  superheated  blood. 

The  Action  of  Cold  Upon  Respiration. 

As  in  the  case  of  heat,  so  with  cold  or  cold  baths,  general  or  local 
applications  produce  immediate  spasmodic  and  interrupted  respira- 
tion, frequently  accompanied  by  a  sense  of  strangulation.  These  last 
a  variable  length  of  time,  from  a  few  seconds  to  minutes  if  the  bath 


PHYSIOLOGICAL  ACTION  OF  WATER.  33 

is  continued,  at  which  time  the  system  adapts  itself  to  the  changed 
conditions,  and  a  more  steady,  equable  movement  results. 

The  irregular  breathing  is  due  to  the  more  or  less  spasmodic  action 
of  the  ordinary  and  extraordinary  muscles  of  respiration,  especially 
the  diaphragm.  This  muscle  oftentimes  contracts  to  such  an  extent 
as  to  "cut  off  the  wind,'*  an  exceedingly  disagreeable  sensation.  Con- 
traction of  the  abdominal  wall  muscles  and  the  adduction  of  the  arms 
to  the  chest  walls  frequently  occur  at  this  time.  These  effects  may 
be  readily  produced  by  local  cold  applied  to  the  chest  walls  and  ab- 
domen. In  moderate  degree  I  have  observed  them  from  an  ice-bag 
placed  over  the  precordium.  During  this  time  the  intake  of  oxygen 
and  the  output  of  C02  is  lessened.  These  spasmodic  effects  result 
from  the  thermic  irritation  conveyed  from  the  surface  to  the  medulla, 
from  there  reflected  upon  the  lung  and  chest  muscles,  as  well  as  the 
direct  effect  of  the  cold  application  to  the  skin  and  muscular  struc- 
tures of  the  chest  and  abdomen,  being  thus  accentuated  by  a  general 
and  local  action  reinforcing  one  another.  When  the  vital  responses 
adapt  themselves  to  the  external  irritation,  the  vascular  stream  sets 
in  from  the  periphery  and  better  supplies  the  medulla  with  arterial 
blood,  lessening  its  irritability.  With  the  cessation  of  the  bath  and 
the  induction  of  reaction,  respiratory  action  becomes  slower,  deeper  and 
easier.  There  is  a  sensation  as  though  the  lungs  had  had  a  load  lifted 
from  them  were  broader  and  more  capacious.  For  a  considerable 
time  thereafter  the  respirations  are,  by  actual  chest  measurement, 
deeper,  the  chest  expanding  from  one-half  to  one  inch.  This  I  have 
personally  observed  upon  myself  and  other  individuals,  both  sick  and 
well.  With  the  deeper,  broader  respirations,  diffusion  of  gases  takes 
place,  and  we  find  the  oxygen  content  and  C02  elimination  markedly 
increased.  Friedrich  found  this  to  be  true  when  the  naked  body  was 
exposed  to  cold  air  alone,  especially  the  increased  oxygen  consumption. 
All  these  effects  are  enhanced  if  made  abruptly  and  accompanied  by 
mechanical  stimulation,  as  in  the  douche,  and  are  roughly  propor- 
tional to  the  lowness  of  temperature.  The  wide  systemic  results  that 
follow  the  addition  of  oxygen  to  the  blood  stream,  the  metabolic 
changes  that  follow,  the  added  facility  of  elimination  from  better  ox- 
idative processes,  make  this  feature  of  hydriatics  a  most  important 
and  far-reaching  one.  The  alternate  application  of  heat  and  cold 
produces  similar  effects,  but  more  pronounced.  Reaction  is  more 
quickly  favored. 

These  physiological  changes  are  induced  by  warm  or  hot  water 
at  much  lower  temperatures  than  where  hot  or  superheated  air  is 
employed.  Radiant  energy  or  light  acts  more  quickly  and  at  lower 
temperatures,  owing  to  its  tissue  penetrability,  or  transilluminating 
property. 


34  PRACTICAL  HYDROTHERAPY. 

Physiological  Action  Upon  Metabolism. 

By  metabolism  we  mean  all  those  intricate  processes,  physical, 
chemical  and  physiological,  by  which  the  human  or  animal  economy 
brings  about  its  tissue  changes,  anabolic  or  reconstructive,  catabolic 
or  destructive. 

The  normal  adult  human  maintains  a  metabolic  equilibrium  by 
the  absorption  and  assimilation  of  food  products  and  water  from 
the  digestive  tract,  and  oxygen  from  the  lungs ;  appropriating  these 
properly  prepared  pabula  by  his  tissues,  and  removing  from  the  sys- 
tem the  end-products  of  tissue  change  through  the  excretory  organs, 
and  carbon  dioxide  from  the  lungs. 

When  metabolism  is  equally  balanced,  the  input  is  just  sufficient 
and  proper  to  meet  all  the  demands  of  functional  activity,  repair  all 
waste,  furnish  sufficient  force  and  heat,  the  output  of  waste  material 
being  promptly  and  properly  removed  in  toto. 

The  great  channel  by  which  the  pabulum  is  conveyed  to  the  tissue, 
and  the  detritus  removed  from  it,  is  the  blood ;  and,  as  we  have  here- 
tofore noted,  this  organ,  in  its  circulatory  activity,  is  greatly  influ- 
enced by  hydriatic  procedures.  Metabolism  of  tissue  may  be  influenced 
by  five  means,  as  follows : 

1.  Through  the  circulation;  an  activity  of  function  resulting  from 
an  increased  quantity  of  blood  flowing  through  the  organ  or  part. 

2.  Through  the  blood ;  better  composition,  and  in  which  the  pres- 
ence of  increased  O  stimulates  oxidation  and  tissue  change. 

3.  Through  blood-prcssurc ;  an  increased  blood-pressure  causing 
more  blood  to  pass  through  the  capillary  walls,  and  thereby  favoring 
nutritive  changes. 

4.  Through  temperature  changes  upon  the  tissues. 

5.  Through  the  nervous  system :  especially  the  vasomotors  in- 
creasing the  circulation  in  a  part ;  stimulation  of  trophic  nerves,  that 
increases  the  capacity  of  the  tissues  to  absorb  nutriment. 

To  attempt  to  describe  in  detail  the  manifold  and  intricate  nature 
of  the  changes  that  take  place  is  foreign  to  this  work,  but  the  influ- 
ence of  hydriatic  procedures  upon  metabolism  will  be  considered 
under  four  headings : 

1.  Secretion. 

2.  Absorption. 

3.  Tissue  change. 

4.  Excretion. 

1.  Secretion. — The  importance  of  this  function  of  metabolism  can 
hardly  be  overrated.  When  we  reflect  that  upon  glandular  structures 
the  body  depends  for  all  those  juices  by  means  of  which  food  is  ren- 
dered soluble ;  for  those  more  or  less  understood  and  appreciated  in- 
ternal juices  or  secretions ;   for  lubrication  and  other   functions :   we 


PHYSIOLOGICAL  ACTION  OF  WATER.  35 

realize  that,  no  matter  where  we  turn,  we  find  the  glandular  cell  wait- 
ing to  respond  to  stimuli.  Nowhere  in  the  broad  range  of  physiology 
and  pathology  do  we  find  such  satisfactory  returns  for  hydriatic  intel- 
ligence as  in  this  field,  for  chronic  glandular  disturbances  are  among 
the  constant  pictures  before  the  clinician's  eye.  Study,  reflection  and 
observation  have  taught  me  the  profound  influence  of  hydrotherapy — 
heat  and  cold — upon  these  structures.  In  general  terms  it  may  be 
stated  that  brief  applications  of  thermic  stimuli,  whether  hot  or  cold, 
stimulate  secretion,  differing  in  degree  rather  than  in  toto;  long- 
continued  applications  depress. 

This  difference  asserts  itself,  however,  principally  because  it  acts 
on  the  muscular  fibers  of  these  structures :  that  cold  is  tonic,  heat 
atonic.  I  have  repeatedly  demonstrated  the  secretory  stimulation  of 
heat  and  cold  applied  to  the  salivary  and  hepatic  cells.  Very  hot  and 
very  cold  brief  treatments  resemble  one  another  closely;  between 
are  all  gradations.  The  marked  accompanying  influence  of  hydriatics 
upon  the  circulation  furnishes  the  medium  from  which  the  aroused 
cells  may  select  the  pabulum  to  reconstruct  their  own  tissues,  if  they 
be  defective,  and  from  which  to  make  a  better  and  freer  secretion. 
Thus  physiology  clearly  and  simply  answers  the  question  why  a  crip- 
pled glandular  organ  does  better  work  in  the  economy,  regains  its 
normal  tone  and  activity,  under  hydriatics.  General  applications  of 
heat  and  cold  influence  the  general  secretory  functions  of  the  body, 
while  local  effects  may  be  obtained  by  concentrating  upon  certain 
organs  and  regions.  Both  general  and  local  effects  are  enhanced  by 
abruptness,  as  well  as  mechanical  stimulation,  when  it  accompanies 
the  application.  Among  the  noticeable  general  results  of  hydriatics 
may  be  mentioned  increased  appetite,  greater  relish  and  capacity  for 
food — an  important  element  in  chronic  cases. 

2.  Absorption. — Without  proper  absorption,  the  pabula  prepared 
by  glandular  organs  would  remain,  and  become  useless  to  the  body. 
Secretion  and  absorption  are  so  intimate  that  what  influences  one  cer- 
tainly influences  the  other.  As  we  have  seen,  the  better  juices  and 
better  prepared  foodstuffs  resulting  from  glandular  action  are  in 
shape  for  quicker  and  surer  absorption ;  and,  as  in  the  case  of  secre- 
tion, so  with  absorption,  the  more  active  blood-stream,  the  more  ac- 
tive lymphatics  and  lacteals.  take  up  the  dissolved  foodstuffs,  and 
more  rapidly  and  certainly  distribute  them  to  the  tissues  and  organs. 
Nor  does  this  stop  with  the  alimentary  canal.  As  we  have  seen,  the 
respiratory  activity  being  greater  and  the  oxygen  input  larger,  greater 
absorption  of  this  living  fire,  oxidation,  occurs,  and  the  augmented 
quantities  of  it  in  the  blood  results  in  the  better  burning  of  waste  ma- 
terials, just  as  a  stronger  draft  in  a  chimney  better  consumes  the  coal. 
But  there  are  still  other  absorbary  processes  that  are  equally  impor- 
tant, and  which  respond  quickly  to  hydriatics,  these  being  the  inter- 


36  PRACTICAL  HYDROTHERAPY. 

and  intra-cellular  ones.  Here  the  tissues  absorb  the  new  and  better- 
prepared  elements,  giving  up  "old  lamps  for  new,"  while  the  remain- 
ing surplus  is  better  and  more  rapidly  cared  for  by  the  lymphatics, 
because  of  the  added  muscular,  glandular,  nervous  and  circulatory 
influences.  As  in  secretion,  so  in  absorption,  we  secure  the  same  ther- 
mic results;  general  applications  producing  general,  local  ones,  local 
results.  Abruptness  and  mechanical  stimulation  enhance.  "By  intro- 
ducing belladonna  into  the  rectum,  and  observing  the  length  of  time 
that  elapsed  before  dilatation  of  the  pupil,  and  other  characteristic 
physiological  effects,  Fleury  showed  that  absorption  from  the  alimen- 
tary canal  is  very  greatly  accelerated  by  the  cold  douche.  His  ex- 
periment, and  those  of  others,  show  clearly  that  cold  applications  to 
the  surface  stimulate  absorption  by  the  gastric  and  intestinal  mucous 
membrane,  and  consequently  that  such  applications  must  favor  nutri- 
tion by  promoting  alimentation."  4 

The  author  has  carefully  studied  clinically  the  influence  of  the 
hot,  cold,  and  alternate  hot  and  cold  douche  applied  to  spine  and 
abdominal  wall,  and  has  observed  greater  absorption  and  activity  from 
such  measures,  the  scale  showing  a  notable  gain  in  weight,  lasting 
often  for  months,  and  even  years,  after  a  course  of  hydriatics. 

3.  Tissue  Change. — Through  the  whole  body  functionation  takes 
place,  a  breaking  down  into  detritus,  a  building  up  or  reconstruction 
of  tissue.  This  broad  law  is  applicable  to  every  organ,  tissue  and 
function,  and  is,  in  its  entirety,  one  of  the  most  complicated  of  the 
many  intricate  activities  of  the  marvelous  human  body.  That  this  is 
best  accomplished  with  an  actively  distributed  circulation,  under  nor- 
mal pressure,  high  oxygen  content  and  proper  nerve  force,  no  one 
will,  I  believe,  deny.  That  normality  of  tissue  action,  ana-  and  kata- 
bolic,  is  promoted  in  health,  and  changed  under  pathological  condi- 
tions, is  so  patent  to  any  one  who  uses  this  agent  that  it  is  but  a  trite 
observation  to  make. 

Winternitz  has  called  attention  to  the  fact  that  "when  healthy 
persons  who  have  for  weeks  displayed  almost  stationary  weight,  are 
subjected  to  heat  abstraction  once  or  several  times  daily,  it  will  be 
observed  that,  if  the  other  hygienic  and  dietetic  conditions  remain  un- 
altered, especially  the  quale  and  quantum  of  the  diet,  a  number  of 
these  persons  will  undergo  a  slight  addition  to  their  original  weight, 
whilst  the  greater  number  will  suffer  a  reduction  of  weight  thereby." 

For  the  past  fifteen  years  all  cases  coming  under  my  personal  ob- 
servation have  been  carefully  studied  with  regard  to  the  loss  or  gain 
of  weight,  under  most  varying  conditions.  I  believe  it  to  be  true  that 
both  normal  and  pathological  persons,  as  a  rule,  will  remain  stationary 
in  weight,  or  reduce  their  weight,  when  their  hygienic  life  and  diet 
remain   exactly   the   same.      This   we   observe   in   treating   the   obese. 

4  Kellogg,    J.    H.:    "Rational    Hydrotherapy,"    1906,    p.    121. 


PHYSIOLOGICAL  A(  TION  OF  WATER.  37 

On  the  oilu-r  hand,  we  have  observed  that,  oxidation,  secretion  and 
absorption  being  active,  more  food  is  taken,  digested  and  absorbed. 
My  experience  with  several  thousand  (three  to  four)  eases  has  shown 
me  that  we  can,  by  increasing  the  quantity  or  changing  the  quality  of 
the  food,  regulate  to  a  certain  degree  the  gain  of  weight;  and,  further- 
more, this  gain  will  be  of  an  entirely  different  character  of  tissue — 
stronger,  more  active  and  firmer  to  the  touch.  These  changes  are  more 
prompt  where  the  patient  has  been  subjected  to  a  heating  method 
that  stimulated  diaphoresis,  followed  by  brief  tonic  cold  methods,  me- 
chanical stimulation  enhancing  the  effects,  the  process  in  its  response 
bearing  a  relation  to  the  capacity  of  the  patient  to  respond  to  thermic 
and  mechanical  irritation.  That  the  nervous  system  is  the  largest  fac- 
tor in  bringing  about  these  changes  cannot,  I  believe,  be  denied,  for 
it  is  through  this  system  that  the  internal  visceral  effects  are  produced 
by  reflex  action.  As  we  shall  see,  the  powerful  effects  upon  muscular 
tissue  aid  the  result,  for  bodily  oxidative  processes  are  intimately 
associated  with  muscular  activity. 

Roehrig  and  Zuntz  found  "that  changes  in  the  intensity  of  tissue 
metamorphosis  appeared  to  be  traceable  to  certain  cutaneous  nerve 
fibrils  which  were  excited  by  cold.  These  nerve  fibrils  could  also  be 
aroused  by  other  stimuli,  such  as  strong  salt  baths,  with  the  same 
effect  of  increasing  tissue  change." 

An  interesting  point  in  connection  with  these  experiments  was  that 
these  increased  oxidation  processes  seemed  to  be  located  in  the  mus- 
cles, through  their  nerve  supply,  and  that  the  muscles  need  not,  for 
this  purpose,  be  aroused  sufficiently  to  produce  visible  contractions. 
This  was  made  evident  by  experiments  made  upon  animals,  in  which 
the  innervation  of  the  muscles  was  placed  in  abeyance  by  arrow 
poison.  In  such  animals  tissue  change  was  not  only  not  increased  by 
cold,  but  was  reduced  one-half. 

"They  concluded  that  the  source  of  tissue  changes  in  the  animal 
economy,  when  affected  by  cold,  lies  in  the  innervation  of  the  mus- 
cles, and  this  is  confirmed  by  the  trite  physiological  fact  that  the  larger 
part  of  all  combustion  processes  occurring  in  the  animal  body  may 
be  traced  to  the  muscles."     (Baruch). 

Raising  the  body  temperature  by  heat  or  hot  water  increases  to 
a  certain  extent  tissue  changes,  but  is  followed  by  an  atonic  state, 
from  which  the  body  slowly  returns  to  the  normal.  Cold,  per  contra, 
is  a  direct  and  immediately  stimulating  measure,  tonic  in  action. 
Alternate  applications  enhance  one  another  as  well  as  produce  more 
permanent  results.  Mechanical  stimulation  augments  the  results. 
It  may  unhesitatingly  be  stated  that  the  nutrition  of  those  in  health, 
and  especially  those  diseased,  is  increased  by  the  external  application 
of  heat  and  cold  to  the  cutaneous  surface. 

4.  Excretion. — Without   excretion   death   rapidly   ensues;   in    fact, 


38  PRACTICAL  HYDROTHERAPY. 

the  failure  of  certain  of  its  various  organs  rapidly  renders  the  individ- 
ual helpless,  notably  that  of  the  lungs  and  kidney.  Waste  materials  re- 
sult from  bodily  activity ;  they  are  the  ashes  from  the  tissue  fire.  The 
principal  organs  involved  are  the  kidneys,  lungs,  bowel,  and  second- 
arily the  skin.  This  latter  becomes  more  actively  eliminant  when  any 
other  function  or  organ  is  crippled.  That  the  bowels  may  for  years 
fail  to  properly  remove  waste  material,  is  a  common  everyday  obser- 
vation, and  the  organism  seems  to  fairly  well  adapt  itself  to  this 
state,  although  detrimental  to  health,  comfort,  and  provocative  of 
disease.  Not  so  with  the  lung  or  kidney  ;  their  failure  in  great  degree, 
even  for  short  time,  is  likely  to  prove  fatal. 

With  the  unusually  increased  pulmonary  activity  and  exchange  of 
gases  we  would  have,  as  we  have  shown,  a  greatly  augmented  excre- 
tion from  the  lungs.  This  consists  principally  of  C02,  although  am- 
monia, extractives,  etc.,  are  present.  In  exchange  for  these  waste 
noxious  products,  oxygen  in  large  volume  is  absorbed  into  the  blood, 
this  with  other  factors  permanently  raising  the  hemoglobin.  All 
bodily  processes  requiring  oxygen  are,  therefore,  bathed  in  this  gas, 
and  as  a  resultant  the  waste  products  of  the  body  are  made  ready  for 
exit.  This  increased  oxidation  (and  muscular  activity)  may  be  used 
to  consume  a  pathological  excess  of  sugar  in  the  blood,  as  in  a  dia- 
betes. That  urea  excretion  rises  under  hydriatics  I  have  demon- 
strated by  hundreds  of  estimations.  Formanek  observed  that  after 
cold  baths  were  given  daily,  so  that  a  more  decided  abstraction  of 
heat  took  place,  the  elimination  of  nitrogen  in  the  urine  increased 
markedly,  and  the  excretion  of  uric  acid  generally  kept  pace  with  the 
excretion  of  nitrogen.  In  addition,  a  large  number  of  extractives 
usually  calculated  as  nitrogen  sank  after  the  bath  period  to  1.5  per 
cent.,  showing  that  the  largest  portion  of  the  nitrogen  was  used  up 
for  the  formation  of  the  normal  end-products  of  tissue  change,  thus 
leaving  but  a  small  portion  for  these  extractives. 

The  influence  of  cold  procedures  upon  the  urine  may  be  readily 
studied  by  those  who  will  take  the  trouble  to  estimate  the  specific 
gravity  and  urea  of  urine  seven  or  eight  hours  after  such  a  treatment. 
Strasser5  found  that  the  elimination  of  practically  all  waste  products 
is  increased  after  the  cold  bath.  Not  only  is  urea  and  the  urotoxic 
groups  eliminated  more  freely,  but  we  frequently  find  a  diminution 
of  uric  acid,  showing  more  perfect  changes  with  increased  oxidation. 
In  addition  to  this,  he  found  that  there  was  an  increased  excretion  of 
nitrogen,  "which  must  be  ascribed  directly  to  the  increased  activity 
of  the  organism,  a  more  active  change,  due  to  a  better  utilization  of 
the  food.  The  promptness  with  which  this  effect  occurred  is  evidence 
of  this  fact."  Some  recent  studies  by  the  author,  in  his  private  labora- 
tory, upon  the   specific   gravity,   urea,   phosphates   and  purin   bodies, 

5   Strasser:    "Hydrotherapy,"   Cohen's   Physiological   Therapeutics,    1902. 


rmSlOLOGICAL  ACTIOS  OFWATEK.  » 

of  short  cold  percussory  appl.cat.ons  over  the  Uve 
infrequently  being  followed  by  the  so-  ailed    b, o us     » 

appHcations,  abrupt ^t^ST^-S  — •  do  "* 

in  their  action.     Heat  or  water  mea.u      ,  excretion  of 

produce  ah  these  effects   bo,  -^^Uhough  increasing  the 
CO,  and  the  absorp  .on  of  O  Jr        ^         g  ^   ^  ^ 

terminal  products   in   the  urine.     ^  changes  we  have 

ro/rf  increases  the  el.mmat.on  of  CO„  increases  tne  V 

decreases  the  formation  and  ...creases  the     hmn Uoo  of  P^ 

ducts  and  toxic  material  through  the  W^  W M 
^^rKT^rr^i.  removal  of  one 
Lnl  wi.f  mar  the  beauty  and  perfection  of  the  who.e. 

Physiological  Action  Upon  the  Nervous  System. 
The  extensive  area  of  the  cutaneous  surface  of  J£— ** 

logical  or  therapeutic  response     To  those  who  con,ideration  of 

brought  about  through  its  dominating  influence  upon  . 

and  function  of  the  human  body  possession 

i„   a  cursory   and   superficial   way  touch  upon   the  mtlue 

™s  systems  ^t^^TtnL^  «  -V 


40  PRACTICAL  HYDROTHERAPY, 

The  cerebrospinal  nervous  system  consists  of  brain,  medulla  and 
basal  ganglia,  spinal  cord  and  peripheral  nerves.  The  peripheral 
nerves  are  spread  in  a  vast  network  over  the  entire  skin  surface,  are 
both  efferent  and  afferent,  carry  common  and  special  sensations  to  and 
from  the  skin  to  nerve  centers  located  in  the  central  nervous  system. 
They  are  distributed  to  muscles,  glands  and  other  structures  in  the 
skin,  to  the  large  and  small  skeletal  muscles,  and  intimately  connected 
with  one  another.  Each  segment  of  the  cord,  the  medulla,  basal 
ganglia,  and  even  the  brain  itself,  are  in  close  direct  and  reflex  con- 
nection with  each  of  these  parts,  and  each  with  one  another.  From 
cord,  medulla  and  brain  pass  the  cranial  and  spinal  nerves  that  govern 
and  control  all  the  tissues  of  the  body.  All  of  these  segments  and 
levels  are  in  turn  connected  with  the  sympathetic  nervous  system  in 
hundreds  of  ways.  It  is  upon  these  peripheral  sensory  nerves  that 
the  hydriatist  plays  with  his  thermic  and  mechanical  stimuli ;  from 
their  terminations  myriads  of  impressions  pass  centripetally  (inward) 
to  the  cord  impressing  its  centers  in  the  gray  matter ;  on  and  upward 
to  the  medulla  and  basal  ganglia  to,  finally,  terminate  in  the  gray 
matter  of  the  cortex.  From  these  "levels,"  cord,  base  and  cortex, 
each  sends  out  its  own  "reflex"  messages  the  result  of  the  stimulation, 
so  that  all  tissues,  organs,  structures  and  functions  correlated  to  the 
level  are  made  to  feel  the  imprint  of  far  distant  sensory  perturbations. 
Here,  then,  are  the  wires,  here  the  messages,  here  the  "overseers" 
that  raise  and  lower,  restrain  or  urge,  stimulate  and  sedate ;  here  is 
the  method  by  which  far  distant  processes  are  brought  in  touch  and 
their  action  harmonized.  Were  the  peripheral  sensory  nerves  removed 
the  hydriatic  response  would  be  an  unknown  thing.  But  the  human 
being  is  a  sentient  animal  that  responds  accurately,  surely  and  promptly 
to  the  master  hand,  and  thus  those  changes  at  which  so  many  marvel 
come  to  pass,  even  as  the  day  succeeds  the  night.  As  we  have  here- 
tofore said,  hydriatics  produce  perturbations  of  these  sensory  nerves, 
the  impressions  of  which  leave  their  imprint  upon  the  central  nervous 
system  as  well  as  upon  the  tissues  controlled  by  it. 

Ably  seconding  the  cerebro-spinal,  is  the  sympathetic  or  ganglionic 
nervous  system,  consisting  of  a  series  of  ganglia  located  in  different 
portions  of  the  body.  A  long  chain,  the  intervertebral,  extends  from 
the  upper  cervical  to  the  coccygeal  region,  lying  on  either  side  and 
between  the  vertebras.  They  are  connected  with  one  another  and  each 
other,  and  send  filaments  to  the  ganglia  in  the  viscera.  There  are 
ganglia  in  the  thorax,  abdomen  and  pelvis,  and  subordinate  ganglia 
in  certain  organs  and  tissues.  The  fibres  from  this  system  are  dis- 
tributed to  and  follow  the  ramifications  of  the  blood-vessels  every- 
where, and  are  intimately  associated  with  the  control  of  vital  activities. 
This  "vegetative"  system,  especially  the  great  ganglia  in  the  interior 
of  the  trunk,  receives  impressions  from  the  nerves  distributed  over  the 


PHYSIOLOGICAL  ACTION  OF  WATER,  41 

body  and  from  the  subordinate  ganglia,  rearranging  and  controlling 
them. 

It  must  be  borne  in  mind  how  richly  the  corium  is  supplied  with 
blood-vessels,  therefore  richly  with  sympathetic  nerve  fibers.  These 
respond  with  great  rapidity  to  thermic  impressions. 

This  system,  then,  has  to  look  after  principally  the  metabolic  pro- 
cesses of  the  body — secretion,  absorption,  tissue  change,  excretion — 
and  the  circulatory  activity  that  accompanies  their  function.  While 
closely  associated  with  the  cerebro-spinal,  it  is  not  controlled  by  it. 
It  may,  by  its  action  upon  circulation,  in  its  turn  change  the  quantity 
of  blood  in  the  brain,  and  affect  thereby  mental  activity  and  even 
consciousness  itself.  Under  its  beneficent  influence  the  lungs,  heart, 
liver,  stomach,  intestines,  kidney  and  reproductive  organs  functionate. 
It  is  thus  easy  to  see  that  through  these  marvelous  and  wonderful 
systems  of  nerves,  the  clinician  may,  by  properly  applying  thermic 
and  mechanical  stimuli,  so  vary  the  normal  and  pathological  pro- 
cesses of  the  body  as  to  enhance  the  former  and  correct  the  latter. 
He  can  dominate  the  circulation,  change  nutrition,  increase  or  decrease 
function,  and  even  change  the  current  of  thought.  Mere,  then,  lies  a 
method  open  to  all,  that  may,  through  its  action  upon  the  nervous 
system,  be  made  to  reach  the  foundations  of  life  itself.  Within  the 
nerve  tissue  itself  the  "neurons."  or  nerve  cells,  carry  on  this  work. 
They  consist  of  a  neuron  body,  from  which  project  wedge-like  pn> 
cesses,  the  dendrites ;  a  neuraxon  or  nerve  fiber,  "end-brushes"  or 
contacts  and  tetodendrons  or  end-plates.  These  cellular  structures  are 
in  relation  with,  are  superimposed  in  groups  above  and  around  one 
another.  A  number  of  years  ago  Waldemeyer  noticed  that  the  "end- 
brushes"  moved,  were  attached  and  detached,  and  since  his  commu* 
nication  we  have  seemed  to  have  a  clearer  idea  of  this  complicated 
problem.  It  is  now  held,  with  sonic  dissent,  that  the  neuron  is  a 
distinct  and  separate  entity,  influenced,  like  all  other  cellular  structures 
of  the  body,  and  being  capable  of  projection  and  retraction.  It  is  by 
means  of  these  movements  that  we  are  able  to  form  a  rational  ex^ 
planation  of  varying  nervous  phenomena. 

That  the  neurons  are  similar  in  action  to  protoplasmic  bodies  we 
can  hardly  doubt.  We  know  full  well  the  action  of  heat  and  cold  upon 
the  white  blood  cell  and  ameba,  the  former  increasing,  the  latter 
decreasing  movement,  so  we  can  believe  that  the  movements  of  the 
dendrites  would  be  likewise  affected.  Thus  would  be  explained  the 
exciting  effects  of  heat  by  increased  movements  of  the  dendrites,  the 
reverse  in  the  case  of  cold. 

The  Action  of  Heat  Upon  the  Nervous  System. 

When  the  body  is. surrounded  by  a  medium  higher  in  temperature 
the  sensory  nerves  convey  the  thermic  impressions  from  the  periphery 


42  PRACTICAL  HYDROTHERAPY. 

to  the  centers  in  the  cord,  medulla  and  brain.  Speaking  in  general 
terms,  it  may  be  said  that  the  appreciation  by  the  nervous  system  of 
heat  is  slow  as  compared  to  cold,  the  rapidity  of  heat  response  being, 
of  course,  proportional  to  the  rise  of  the  temperature  above  the  body 
heat.  Heat  in  its  primary  action  upon  the  nervous  system  is  that  of  a 
stimulant,  or  even  excitant,  according  to  its  degree  and  duration.  After 
a  variable  state  the  superheated  vascular  stream  coming  from  the 
surface  where  the  blood  has  absorbed  heat  bathes  all  nerve  tissue,  so 
that  the  organism  and  its  force  rise  to  meet  and  throw  off  or  nullify 
the  influences  that  are  acting  upon  the  surface.  Heat  loss  is  now 
encouraged  by  the  increased  surface  vascularity  and  perspiration. 
Even  under  proper  adjustment  and  heat  loss  to  balance  the  rise  in 
temperature,  we  find  that  there  remain  in  the  tissues,  and  especially 
the  nervous  system  itself,  waste  materials  and  toxins  that  have  a 
depressing  effect — in  fact,  are  fatigue  poisons.  Relaxation  in  general, 
and  a  debilitating  feeling  in  particular,  the  result  of  heat's  own  ac- 
tion on  nerve  tissue,  results,  the  individual  feeling  a  sense  of  lassi- 
tude proportional  to  his  sensitiveness  to  heat  and  the  duration  of  the 
exposure.  That  some  of  these  effects  are  due  to  the  action  of  heat 
upon  cerebral  tissue  is  shown  by  the  fact  that  cold  to  the  head  will, 
in  nearly  all  cases,  prevent  these  unpleasant  cerebral  symptoms  and 
enable  the  body  to  be  longer  exposed  to  higher  temperatures.  The 
peripheral  nerves  themselves  become  sensitive  or  acute,  responding  bet- 
ter to  stimuli  than  under  ordinary  circumstances.  The  spinal  cord, 
medulla  and  basal  ganglia  are  more  reflexly  active.  Owing  to  the 
attempt  to  prevent  heat  formation,  the  oxidative  processes  of  the  body 
are  lessened,  waste  materials  accumulate  and  by  their  presence  oppress, 
excite,  and  add  to  the  lack  of  vitality.  All  these  effects  are  more 
rapidly  produced  where  hot  air  is  inhaled ;  from  hot  air  quicker 
than  water,  and  still  faster  from  radiant  energy  that  penetrates 
tissue. 

The  neutral  line — temperatures  between  92°  and  96°  F. — pro- 
duces an  action  due  to  its  very  negativeness.  It  possesses  no  thermic 
properties,  therefore  the  essential  feature  of  peripheral  nerve  pertur- 
bation is  absent.  The  peripheral  nerve  terminations,  bathed  in  a  fluid 
that  renders  them  softer,  and  hence  less  conductive,  free  from  thermic 
stimuli  from  the  water,  the  usual  atmospheric  and  other  cutaneous 
irritations  shut  off,  become,  from  the  very  absence  of  external  activ- 
ity, calm  and  quiet.  Unable  to  eliminate  by  perspiration,  the  skin 
becomes  moister,  more  succulent  and  less  sensitive,  from  its  own  con- 
tained water.  Restlessness,  irritability,  nervousness  and  excitement 
are  so  diminished  as  to  almost  insure  prompt  sedation.  In  Strumpell's 
celebrated  case,  where  the  only  avenues  of  communication  were  one 
eye  and  one  ear,  the  shutting  of  one  and  the*  closure  of  the  other 
shortly  induced  sleep,  owing  to  lack  of  excitation.     It  is  in  a  similar 


PHYSIOLOGICAL  ACTION  01'   WATER.  43 

manner  that  neutral  temperatures  exercise  their  characteristic  action 
of  sedation,  the  result  of  an  absence  of  peripheral  stimulation. 

The  Action  of  Cold  Upon  the  Nervous  System. 

Cold,  per  contra,  in  its  action  is  quick  and  decisive.  Almost  coin- 
cident with  its  striking  the  skin  its  disagreeable  (to  most  people) 
impression  is  carried  centripetally,  rousing  the  centers  of  the  cord, 
medulla  and  brain.  How  noticeable  is  the  effect  of  a  dash  of  cold 
water  upon  the  face  of  a  fainting  person,  the  rousing  effect  of  cold 
water  in  the  lethargy  of  alcoholism!  It  is  often  ten,  twenty,  a  hun- 
dred times  more  rapid  than  heat.  Brief  cold  applications  are  essen- 
tially tonic  in  action,  probably  more  nearly  an  actual  tonic  to  nerve 
and  general  tissue  than  any  other  medicament  or  method.  The  first 
effect,  as  I  have  said,  is  disagreeable,  uncomfortable,  accompanied 
probably  by  rigor  and  gasping.  If  the  duration  is  brief,  reaction,  a 
true  nervous  phenomenon,  takes  place,  followed  by  all  the  pleasant 
sensations  to  be  hereafter  described.  The  cutaneous  perturbations 
set  up  by  cold  reach  the  cord,  medulla,  basal  ganglia  and  brain,  the 
ganglia  and  nerves  of  the  sympathetic  system,  and  start  in  action  the 
thousand  and  one  effects  we  have  heretofore  described,  and  which 
influence  temperature,  circulation,  respiration,  metabolism,  muscular 
tissue,  etc.  That  these  results  are  due  to  nerve  action  alone,  we 
again  quote  that  experiment  where  Naumann  separated  all  the  parts 
of  the  posterior  extremity  of  a  frog,  so  that  the  limb  remained  at- 
tached to  the  body  by  the  sciatic  nerve.  He  then  applied  cold  to 
the  leg,  and  observed  that  if  the  cold  were  moderate  there  was  a  dimi- 
nution in  the  capillary  circulation  of  the  mesentery,  but  when  the  appli- 
cation of  the  cold  was  prolonged  there  was  a  dilatation  of  the  vessels. 

Upon  mentality,  a  brief  application  of  cold  to  the  head  or  face  re- 
sults in  increased  cerebral  activity,  as  does  a  general  tonic  bath,  more 
noticeable  where  we  employ  percussive  measures,  as  in  the  douche. 
Prolonged  local  cold  to  the  head,  as  well  as  to  the  body,  results  in  a 
lessening  of  mental  activity,  a  drowsiness,  an  incapability  for  cere- 
bration, often  noted  by  those  who  are  lost  in  snow  storms  or  long 
exposed.  The  author  has  personally  experienced  this  numbing  effect. 
There  can  be  no  denial  of  the  fact  that  the  frequent  use  of  general 
tonic  cold  baths  results  in  a  more  active  mentality.  Mental  action 
may  be  stimulated  and  more  work  accomplished  by  certain  local  baths. 
The  author  has  repeatedly  demonstrated  on  his  own  person,  clini- 
cally, the  increased  cerebral  activity  that  follows  the  cool  or  cold 
sitz  bath. 

The  functions  of  the  spinal  cord  are  much  increased  by  cold  appli- 
cations, especially  those  that  govern  nutritive  processes.  Upon  the 
peripheral  nerves  heat  renders  them  more  acute,  as  we  have  noted; 
cold,  on  the  contrary,  blunting  sensation.     This,  is  true  of  the  tactile, 


44  PRACTICAL  HYDROTHERAPY. 

pain  and  other  sensations  present  in  the  skin,  and  to  a  certain  extent 
it  affects  the  nerve  terminations  in  the  muscles,  for  we  have  all  re- 
marked how  clumsy  is  the  cold  hand.  Pain  may  be  abolished  by  very 
low  temperatures,  freezing  by  the  rhigolene  spray  being  formerly 
much  employed  in  minor  surgery.  A  gradual  contact  is  more  plainly 
felt  than  an  abrupt  one,  just  as  a  finer  spray  feels  colder  than  a  coarse 
one,  the  percussion  of  the  heavier  body  of  water  dulling  sensation. 
Reactions  from  these  effects  are,  however,  quicker  under  percussion 
effects. 

Local  applications  of  heat  and  cold  can  be  borne  at  temperatures 
much  higher  and  lower  than  where  they  are  general.  Certain  re- 
sponses, at  different  parts  of  the  body,  may  be  elicited  through  re- 
flex action,  because  of  a  correlation  between  the  surface  skin  and 
deeper  seated  tissues  and  organs.  Alternate  applications  of  heat  and 
cold,  or  heat  followed  by  cold,  may  be  summarized  as  an  accentuation 
of  both  their  physiological  effects  upon  the  nervous  system,  and  should 
always  have  cold  at  the  last  because  of  its  powerful  tonic  effects. 
Both  are  augmented  where  mechanical  stimulation  accompanies  the 
thermic  irritation.  Clinical  observation  and  study  in  health  and  in 
diseased  states  accompanied  by  a  lowering  of  vitality,  lessening  of 
nerve  energy,  a  retention  of  waste  products,  failure  of  elimination 
and  fag,  show  that  the  alternate  application  of  heat  and  cold,  together 
with  suitable  diet  and  rest,  form  one  of  the  most  satisfactory  means 
of  dealing  with  these  conditions. 

Physiological  Action  Upon  the  Muscular  System. 

The  muscles  form  one  of  the  most  extensive  systems  of  the  body, 
and  a  large  part  of  the  body  weight,  especially  the  striated  skeletal 
ones  attached  to  the  bony  framework  for  the  purposes  of  movement 
and  to  subserve  the  needs  of  bodily  activity.  Intermediate  is  the 
heart,  uterus,  etc.,  and  then  the  important  group  of  non-striated  fibers 
that  are  found  in  glands,  blood-vessels  and  other  important  organs 
and  tissues  of  the  body.  All  muscular  movement  is  dependent  upon 
its  nerve  supply  for  activity,  so  that  there  is  a  close  and  intimate 
relation  between  nervous  and  muscular  activity.  The  interruption  of 
nerve  connection  means  muscular  inactivity  and  subsequent  atrophy. 
Muscles  are  richly  supplied  with  blood-vessels,  which  become  dilated 
during  movement  and  draw  into  them  large  quantities  of  blood.  Thus, 
in  a  moving  muscle  there  is  more  blood,  more  oxygen  is  consumed, 
more  carbon  dioxide  given  off,  the  process  causing  destruction  of 
muscular  proteid,  increased  urea  formation  and  the  production  of 
heat. 

It  is  believed  that  the  source  of  most  muscular  energy  is  derived 
from  the  carbohydrates.  This  is  stored  up  in  the  muscles  during 
rest  under  the  form  of  glycogen,  and  consumed  by  muscular  work. 


Plate  12 — Normal  Fatigue  Curve  of  Man  Aged  Twenty-four  Years   (Kellogg). 


Plate  13— Fatigue  Curve  of  the  Same  Subject  After  a  Hot  Bath  (Kellogg). 


PHYSIOLOGICAL  ACTION  OF  WATER.  45 

While  it  is  true  that  this  class  of  foods  furnishes  the  major  part  of 
energy,  still  some  is  undoubtedly  derived  from  proteid  material.  Mus- 
cular tissue  possesses  the  property  of  contraction,  and  this  can  be 
produced  by  numerous  stimuli  applied  directly  to  it  or  acting  upon 
its  nerve  supply.  Muscular  activity  or  contraction  is  essential  to 
well-being  and  health.  Sedentary  states  are  provocative  of  certain 
diseases. 

When  muscular  structures  have  been  used  for  some  length  of  time 
they  become  fatigued ;  that  is  to  say,  there  collects  in  the  muscle 
tissue  waste  products  which  prevent  its  proper  energizing.  The  ques- 
tion of  fatigue  is  largely  determined  by  the  metabolism  that  takes  place 
in  the  muscles.  It  may  be  relieved  by  an  influx  of  fresh  arterial  blood 
— a  fact  that  the  Sandwich  Islanders  take  advantage  of  by  applying 
massage  to  one  of  their  number  should  he  give  out  while  in  swimming. 

This  explains  how  fatigue  is  overcome  by  hydrotherapy,  whether 
it  be  the  result  of  neuro-muscular  activity  within  physiological  limits, 
or  pathological  fatigue,  as  in  neurasthenia. 

We  are  able  to  state  positively,  through  the  curves  shown  by 
Mosso's  ergograph,  that  hydriatic  applications  influence  muscular 
structures. 

The  Action  of  Heat  Upon  the  Muscular  System. 

Heat  or  hot  water  applications  may  affect  skeletal  muscular  tissue 
in  two  ways :  First,  by  reflex  influences  due  to  the  surface  thermic 
irritation  ;  and  secondly,  by  actual  heat  conduction  through  the  skin 
and  cellular  tissues  to  the  muscles  themselves.  Non-striated  and 
other  muscular  tissues  depend  upon  the  first  alone.  Muscles  gradually 
respond  to  warm  or  hot  applications,  relaxing.  The  blood  circulation 
is  greater,  metabolism  increased,  and  excitability  and  capacity  for 
work  diminished.  This  is  readily  appreciated  by  those  who  have 
experienced  the  enervating  effects  of  prolonged  summer  heat,  which 
so  reduces  physical  and  mental  activity.  Where  hot  applications  alone 
are  used,  the  individual  remains  for  some  time  relaxed  and  enervated, 
gradually  returning  to  the  normal.  With  very  hot  baths  there  is  a 
difference ;  they  are  distinctly  stimulating.  The  cleanly  Japanese 
have  for  a  long  time  used  these  baths,  of  short  duration,  at  tempera- 
tures which  the  Occidental  skin  would  hardly  deem  possible  of  stand- 
ing, finding  in  them  a  means  of  stimulation  and  revivification,  over- 
coming fatigue  and  its  incident  depression.  They  resemble  very 
cold  baths  in  this  respect.  Thus  the  Jap  and  John  Bull  use  different 
methods,  but  arrive  at  the  same  results. 

Very  hot  baths  may  be,  therefore,  used  in  cases  where  the  vitality 
is  low — in  fact,  are  to  be  preferred,  as  the  neural  response  to  cold  is 
poor.  These  baths  relax,  sedate,  remove  waste  fatigue  poisons,  as 
well  as  stimulate.     Very  hot  local  applications  produce  a  temporary 


46  PRACTICAL  HYDROTHERAPY. 

pallor,  rigor,  contraction  of  blood-vessels,  goose  skin,  some  pain,  fol- 
lowed almost  immediately  by  redness,  relaxation,  dilated  blood-vessels 
and  comfort.  Muscular  twitching,  spasm,  pain  due  to  contraction, 
to  lessened  blood  supply  or  nerve  irritability  are  relieved  by  their  use. 
We  have  already  noted  heat's  action  upon  the  heart.  The  relaxing 
and  depressing  effects  of  prolonged  heat  can  be  relieved  by  a  cold 
application.     Mechanical   stimulation  accentuates  these  effects. 

The  Action  of  Cold  Upon  the  Muscular  System. 

The  first  effect  of  cold  upon  the  muscular  structures  of  the  body 
is  a  general  rigor,  associated  with  a  contraction  of  the  muscular  fibers 
of  the  skin,  causing  cutis  anserina,  or  the  so-called  "goose  skin."  The 
muscles  of  the  chest  and  abdomen  contract,  producing  gasping  res- 
pirations. Pallor  of  the  skin  is  present,  due  to  contraction  of  the 
circular  muscular  fibers  of  the  blood-vessels,  driving  out  the  blood. 
This  irritability  lasts  for  a  short  time ;  where  the  applications  are 
long-continued,  lessened  muscular  irritability  and  energy  result,  fol- 
lowed by  lassitude  and  inactivity.  Internal  effects  upon  the  muscu- 
lar structures  of  organs  and  far  distant  tissues  are  entirely  through 
nerve  action.  Cold  may  act  in  a  reflex  manner  and  cause  muscular 
structures  of  the  internal  viscera  to  contract,  as  is  frequently  evi- 
denced by  the  fact  that  a  general  cold,  or  even  a  local  application,  may 
produce  evacuation  of  the  bladder.  It  is  a  common  clinical  observa- 
tion that  cold  to  the  general  cutaneous  or  abdominal  surface  causes 
contraction  and  stimulation  of  the  muscular  structures  of  the  intes- 
tine, increasing  assimilation,  overcoming  atony  and  constipation  by 
its  action  upon  their  muscular  tissue. 

Mosso,  by  means  of  his  ergograph,  has  shown,  in  a  series  of  mas- 
terly studies,  the  action  of  cold  upon  muscles,  as  have  Yinag  and 
Maggiora.6 

The  tracings  here  shown  exhibit  in  graphic  manner  the  increase  of 
power  under  cold  water.  It  is  a  true  tonicity  of  tissue,  with  increase 
of  power.  Kellogg  calls  attention  to  the  interesting  fact  that  cold 
may  lessen  the  irritability  of  voluntary  muscles  and  increase  the 
activity  of  the  smooth  fibers,  thus  giving  rise  to  the  appearance  of 
goose  skin.  Muscular  activity  may  be  increased  one-third,  or  even 
more,  which  is  so  well  known  at  the  present  time  that  it  is  utilized  by 
athletes  the  world  over.  No  prize-fighter  would  think  of  entering 
the  squared  arena  without  his  cold  shower  and  rub  down.  Mechanical 
stimulation  or  percussion,  added  to  the  temperature  effects,  as  in  the 
jet  douche,  make  it  probably  the  most  powerful  tonic  stimulant  to 
these  tissues  now  known.  Clinical  observations  and  personal  experi- 
ence but  tend  to  confirm  what  these  investigators  have  experimentally 
determined.     Here,  again,  a  heating  procedure,   followed  by  a  brief 

6  Blaetter  f.  klinische  Medicin,   1892,  Vol.  II,  No.  1.  and  Vol.  Ill,  No.  7. 


(3) 


(1) 


(2) 


(4) 

Plate  \A — (1)  Normal  Fatigue  Curve,  Left  Hand;  (2)  Normal  Fatigue  Curve, 
Right  Hand;  (3)  Fatigue  Curve,  Right  Hand,  after  Bath  50°  F.  for  Fifteen 
Seconds;   (4)   Fatigue  Curves  after  Gradually  Cooled  Bath  (from  Baruch). 


PHYSIOLOGICAL  ACTION  OF  WATER.  47 

cold  bath — that  is,  an  alternation  of  the  two — shows  that  they  rein- 
force one  another's  responses.  Mydriatics  is  the  method  beyond  ques- 
tion for  the  over-strained  and  tired  worker  of  to-day,  as  well  as  for 
the  pathologically  fatigued  neurasthenic. 

Physiological  Action  Upon  the  Blood. 

The  blood  is  a  complex  fluid,  the  composition  of  which  varies  con- 
siderably in  health,  and  markedly  in  disease.  It  contains  all  the  ele- 
ments essential  for  the  growth,  repair  and  functionation  of  tissues 
and  organs,  is  the  life  of  the  body,  and  its  failure  to  reach  any  atom 
means  its  death  and  decay.  It  receives  its  reconstructive  pabula  from 
the  digested  and  soluble  food  of  the  stomach  and  intestines,  its  fluidity 
from  the  water  ingested,  and  oxygen  from  the  lungs.  It  carries  all 
these,  as  we  have  seen,  to  the  tissues,  bathes  them  in  it,  and  allows 
of  specific  selection  of  needed  elements.  It  in  turn  becomes  a  cloaca 
from  which  refuse  detritus  is  removed  to  the  organs  of  elimination. 
It  consists  of  the  plasma,  or  fluid  element,  and  corpuscles,  both  red 
and  white.  The  red  cells  are  engaged  principally  in  supplying  the 
tissues  with  oxygen,  which  is  brought  to  them  in  a  loosely  combined 
state  as  oxy-hemoglobin  (Hb02),  and  which  is  exchanged  for  CO., 
reducing  the  hemoglobin  to  its  venous  state  (Hb).  The  white  cells  are 
reparative  agents,  are  the  "soldiers  of  the  common  good,"  that  as 
phagocytes  fight  invading  bacterial  hosts  and  toxins,  or  furnish  op- 
sonins, that  render  the  bacteria  less  resistent  to  their  action  and 
raise  the  "index"  of  vitality.  YVinternitz7  many  years  ago,  and  later, 
called  attention  to  the  fact  that  hydriatic  procedures  caused  an  increase 
in  the  white  and  red  blood  cells,  especially  the  former,  accompanied 
by  an  augmented  hemoglobin  content.  The  author8  has  in  a  recent 
article  embodied  a  number  of  experiments  made  by  him  with  a  view 
to  confirm  the  foregoing  statements.  It  may  be  said  that  hydriatic 
applications  increase  the  number  and  activity  of  the  corpuscular  ele- 
ments as  well  as  the  amount  of  hemoglobin  present.  This,  however, 
is  not  due  alone  to  increased  formation  of  cells,  which  does  occur,  but 
to  vast  numbers  of  these  bodies  which  were  lying  dormant  in  the  in- 
ternal viscera,  long  bones,  etc.,  and  which  were  pushed  into  and  taken 
up  by  the  more  active  blood  stream.  That  the  quality  and  quantity  of 
the  blood  are  improved  by  hydriatics  is  a  logical  scquitur  of  what  has 
gone  before.  Improvement  of  circulation,  better  secretion,  and  its 
inevitable  improvement  of  digestion ;  more  active  absorption,  hence 
quicker  utilization  of  foodstuffs;  more  perfect  assimilation  and  tissue 
exchange;    rapid  removal  by  the  excretory  organs,  would  mean  more 

7  Winternitz,    Win.:    "Changes   in   the   Blood    Resulting   from    Application    of   Heat    and 
Cold."      Translation,   Modern   Medicine  and  Bacteriological   Review,   December   1893. 

8  Pope,   Curran:   New  York   Medical   Journal,    1907,    "Treatment   of   Anemia  and  Chloro- 
sis," and  read  before  the  Kentucky   State   Medical   Society,   1907. 


48  PRACTICAL  HYDROTHERAPY. 

blood,  better  blood,  cleaner  blood ;  blood  that  has  high  oxygen-absorb- 
ing and  distributing  powers;  a  blood  to  reconstruct  and  heal  tissue; 
blood  whose  phagocytes  and  opsonins  are  ready,  cap-a-pie,  for  the  in- 
vading hosts.  It  is  the  kind  of  blood  the  healthy,  as  well  as  the  sick, 
need  for  the  preservation  as  well  as  restoration  of  health. 

The  Action  of  Heat  Upon  the  Blood, 

Local  heat  of  short  duration  vitalizes  the  white  corpuscular  ele- 
ments of  the  blood  and  increases  greatly  their  activity.  These  flock 
in  large  numbers  to  any  point  where  a  limited  hot  or  very  hot  appli- 
cation has  been  made.  This  is  very  noticeable  after  the  local  use  of 
the  high  temperatures  employed  in  superheated  dry  hot  air.  The 
number  of  red  cells  locally  is  diminished,  as  well  as  their  hemoglobin 
content  and  oxidizing  power.  With  the  large  number  of  leucocytes, 
phagocytosis  and  opsonic  index,  as  shown  by  Metchnikoff,9  is  raised. 
High  temperatures  of  long  duration  weaken  and  destroy  these  cells. 
This  is  one  of  the  dangers  of  fevers.  General  applications  diminish 
the  number  of  both  red  and  white  cells,  due,  as  Winternitz  says,  to 
their  retention  in  the  viscera.  For  this  reason  the  hemoglobin  is  also 
lessened.  Strasser10  has  found  that  general  applications  of  heat  de- 
crease the  alkalinity  of  the  blood  by  the  presence  of  an  added  amount 
of  acid  phosphate.  He  further  observed  a  marked  diminution  in 
the  density — that  is,  the  fluidity — under  heat.  It  therefore  follows 
that  we  have  a  more  acid  and  thickened  blood  stream,  due,  in  my  opin- 
ion, to  a  lessened  quantity  of  liquid  element. 

The  Action  of  Cold  Upon  the  Blood. 

General  and  local  applications  of  cold  increase  the  corpuscular 
elements,  but  the  white  are  proportionately  increased  over  the  red. 
This  is  true  in  a  physiological  response,  and  equally  so  in  fevers, 
Thayer11  having  demonstrated  a  large  increase  after  the  cold  bath  used 
in  typhoid.  With  the  increased  white  cells  we  may  expect  better 
phagocytes  and  opsonic  activity,  repair  of  tissue  and  healing.  The 
greater  number  of  reds,  the  larger  hemoglobin-carrying  power,  mean 
redder  and  richer  blood  of  greater  oxidative  powers,  a  stream  capable 
of  ridding  itself  of  waste  material  and  toxins.  In  the  same  studies, 
Strasser  {vide  above)  demonstrated  a  marked  increase  of  alkalinity 
of  the  blood,  due  to  diminished  acid  phosphate,  sometimes  as  much 
as  50  per  cent.,  together  with  lessened  density,  although  the  actual 
number  of  cells  was  increased.  This  means  a  more  fluid  blood.  As 
a  natural  corollary  we  may  say  that  the  blood  is  not  alone  freed  from 
impurities,  but  those  groups  which  we  may  as  we  please  call  "uric 

9  Metchnikoff,   E. :    "The   New   Hygiene,"    1907,   p.    22. 

10  Strasser,   Alois:    Deutches   medizinische   Zeitschrift.   June    15.    1896. 

11  Thayer,   Wm. :   Johns   Hopkins  Bulletin.    1893.    Vol.    IV.   p.    37. 


PHYSIOLOGICAL  ACTION  OF  WATER.  49 

acid"  or  purins,  or  the  uro-toxic  group,  toxins  and  impurities  of  tissue, 
are  destroyed  and  removed  from  the  body,  via  the  eliminative  organs, 
without  the  intervention  of  chemicals.  The  alternate  or  the  primary 
use  of  heat,  followed  by  cold,  secures  all  the  advantages  of  both  appli- 
cations, the  one  supplementing  the  other,  and  both  enhanced  where 
mechnnical  stimulation  is  superadded.  It  should  never  be  forgotten 
that  hand  in  hand  with  these  changes  is  a  circulation  evenly  and  prop- 
erly distributed  to  all  parts  of  the  body  under  a  stable  and  normally 
acting  nervous  system.  When  thus  purified,  it  fulfills  literally  the 
proclamation  of  Holy  Writ,  "The  blood  is  the  life." 

The  Hydrotherapeutic  Reaction. 

Upon  numerous  occasions  reaction  has  been  spoken  of,  and  it 
now  remains  to  be  considered  in  detail.  The  hydrotherapeutic  reaction 
is  a  response  of  the  vital  activities  of  the  body  to  thermic  and  mechan- 
ical stimuli  of  varying  degree  applied  to  the  cutaneous  surface.  It 
is  the  antithesis  of  the  actions  produced  by  heat  and  cold.  It  is  a  com- 
plicated process,  many-sided,  but  manifested  principally  along  thermic, 
circulatory  and  neural  lines.  The  varying  stimuli  applied  to  the  cu- 
taneous surface  produce  a  primary  or  immediate  result  that  is  followed 
by  secondary  changes  or  reactions. 

General  reactive  responses  (cold)  are  coextensive  with  the  struc- 
tures of  the  body,  every  cell  and  tissue,  every  structure  and  function, 
feeling  its  influence.  In  order  to  have  the  reaction  it  is  essential  to 
have  some  thermic  deviation  above  or  below  the  neutral  zone.  Tem- 
peratures between  92°  and  96°  F.,  strictly  neutral,  are  rarely,  if  ever, 
accompanied  by  mechanical  stimulation,  so  that  their  action  is  purely 
a  temperature  one.  A  bath  that  is  essentially  neutral  checks  the  stim- 
ulation of  vital  phenomena,  and  reaction  is  the  result  of  a  stimulating 
process.  Neutral  temperatures,  it  may  again  be  remarked,  are  in 
their  action  quieting,  nerve-obtunding  and  calmative  to  nervous  action, 
and  it  is  through  nervous  response  that  these  manifestations  are 
brought  about.  The  reactions  associated  with  heat  are  not,  as  a  rule, 
sought,  but  are  more  or  less  depressive,  relaxing  and  atonic  in  char- 
acter. The  action  of  heat  has  been  previously  considered,  and  the 
atonic  responses  are  best  understood  by  grouping  them  in  a  table,  as 
has  been  done  by  Kellogg.12 

Heat. 
ACTION.  REACTION. 

1.  Brief   contraction,   then   dilatation  1.  Vasoconstriction, 
of  the  surface  blood-vessels,  especially 

of  the  small  veins. 

2.  Slight    pallor    if    previously    red,  2.  Pallor. 

followed  by  dusky  redness.  

12  Kellogg,   J.    H. :    "Rational   Hydrotherapy,"    1906,    p.    121. 

V 


50  PRACTICAL  HYDROTHERAPY. 

3.  Sometimes  goose  flesh  appearance  3.  Skin  smooth,  soft  and  moist. 
and  slight  shivering. 

4.  Slowed,      then      quickened      high-  4.  Pulse   frequent,   tension   low. 
tension  pulse. 

5.  Respiration,  at  first  checked,  then  5.  Respiration  frequent,  free,  super- 
frequent  ;   CO*  diminished.  ficial. 

6.  Perspiration,      at     first     checked,  6.  Respiration  lessened, 
then   increased. 

7.  Heating  of  the  skin.  7.  Gradual  cooling  of  the  skin. 

8.  Rise  in  internal  temperature,  S.  Depression  of  internal  tempera- 
from  diminished  heat  elimination.  ture    from    increased    heat    elimination 

and  decreased  heat  production. 

9.  General  nervous  excitation;  a£  9.  Diminished  nervous  and  mental 
moderate  temperature,  sense  of  com-  irritability,  drowsiness  and  depression- 
fort  and  relief. 

10.  Increased    muscular    irritability.  10.  Muscular  weakness  and  indispo- 

sition to  muscular  effort. 

It  will  be  observed  that  the  reactive  results  show  a  general  atonic 
state,  lack  of  nerve  tone  and  muscular  activity. 

Cold,  however,  is,  par  excellence,  the  agent  by  which  we  produce 
the  well-known  effects  of  reaction.  In  studying  reaction  we  must 
remember  the  primary  effects  of  cold  upon  the  periphery ;  the  gasping 
respiration,  refrigeration,  pallor,  cutis  anserina,  contracted  blood- 
vessels, rapid  pulse,  dilatation  of  internal  blood-vessels  and  nervous 
shock  (physiological).  With  the  cessation  of  the  cold  or  withdrawal 
from  the  bath  there  ensues  a  feeling  of  warmth  in  the  skin ;  it  loses 
its  pallor  and  assumes  a  reddish  hue.  Under  the  hand  or  when  friction 
is  applied  it  quickly  "pinks"  up,  or  becomes  red.  The  goose  flesh 
rapidly  subsides,  and  the  skin  may  feel  warm  to  the  touch,  though 
rarely  so.  The  blood-vessels  that  were  contracted  now  dilate,  not  so 
much  as  under  heat,  but  assume  a  median  position  between  heat  and 
cold — the  "tonic"  contraction,  "probably  due  to  an  excitation  of  the 
inhibitory  nerves,  which  overcome  the  action  of  the  vasoconstrictors" 
(Baruch).  This  dilatation  continues  for  some  length  of  time  after 
the  bath,  and  is  the  standard  for  a  normal  skin  circulation.  Accom- 
panying this  is  a  sense  of  glow  or  warmth,  exceedingly  pleasant  to 
feel;  once  experienced  it  is  sought  again.  The  internal  blood-vessels 
are  moderately  contracted,  owing  to  the  greater  quantity  of  blood  in 
the  superficial  blood-vessels.  The  heart's  action  becomes  slower  and 
better,  its  sounds  clearer,  the  pulse  fuller  and  less  rapid,  and  arterial 
tension  is  raised.  The  glandular  activity  of  the  skin  is  increased,  the 
skin  is  moister  and  perspiration  is  present.  For  this  reason  the  indi- 
vidual should  be  protected  by  a  sheet  until  dressed.  Respiration  is 
broader,  deeper  and  freer,  more  oxygen  absorbed,  greater  C02  elim- 
inated, while  the  chest  walls  and  lungs  feel  as  though  there  was  greater 
freedom  of  action.  The  muscles  possess  greater  tone,  and  there  is 
the   feeling  of  greater  power   for  muscular  effort.      Possibly  some 


PHYSIOLOGICAL  ACTION  OF  WATER.  51 

metabolic  changes  take  place  during  this  short  period,  enhancing  the 
sense  of  well-being.  There  is  often  a  sensation  of  tingling  felt  in  the 
skin,  due  to  the  thermic  and  mechanical  action  upon  the  peripheral 
nerves.  Pain  is  lessened,  sensation  acute.  There  is  a  bodily  vigor  and 
tone,  probably  due  to  spinal  action.  The  mental  faculties  become  more 
active,  there  is  an  increased  capacity  for  work,  fogginess  is  cleared 
away  and  mental  clearness  succeeds.  This  general  feeling,  best  de- 
scribed as  a  bein  faisancc,  or  well-being,  is  one  of  the  most  delightful 
and  pleasant  of  the  neural  effects  of  reaction.  The  aim  being  to  secure 
reaction,  care  should  be  taken  to  study  what  will  favor  this  result 
before,  during  and  after  the  bath.  For  this  reason  fatigued  persons 
should  be  carefully  handled  and  rested  before  taking  treatment.  It 
may  be  taken  as  axiomatic  that  the  stronger  and  more  robust  the 
physique  the  better  the  reaction ;  especially  is  this  true  when  persons 
have  been  accustomed  to  the  use  of  cold  water  as  a  daily  procedure. 

Warmth,  both  of  body  and  the  bath-room,  is  a  necessity,  and  this 
may  be  secured  by  any  number  of  measures.  In  strong  persons 
muscular  activity  before  the  bath  favors  reaction ;  in  weak  ones,  rub- 
bing or  friction,  a  hot  enema,  hot-water  drinking,  hot-air  bath,  or, 
what  is  by  far  the  best,  the  incandescent  electric  light  bath,  stimu- 
lating vital  activity  and  heat  production,  may  be  employed.  During 
the  bath  we  can  hasten  the  subsequent  reaction  by  using  mechanical 
or  percussive  measures,  such  as  douches,  friction  over  the  wet 
sheet,  etc. 

The  manner  of  applying  cold  water  to  the  surface  influences  very 
materially  the  question  of  reaction.  A  low  temperature  suddenly 
applied,  with  a  higher  surrounding  temperature,  accompanied  by 
pressure  or  mechanical  effects,  produces  prompt  and  active  reaction. 
This  can  also  be  aided  by  voluntary  movements,  friction  of  the  skin 
surface  by  the  individual  himself,  and  it  may  be  stated  that  friction 
of  any  kind  during  the  application  of  cold  favors  reactionary  influences 
and  prevents  shock  and  collapse,  a  fact  that  will  be  carefully  noted 
when  we  come  to  consider  the  application  of  the  full  bath  in  typhoid 
fever,  the  half-bath  and  dripping  sheet.  Baths  that  are  cold  or  very 
cold,  of  very  brief  duration,  with  mechanical  effects,  hasten  the  result. 
Or  the  hot  and  cold  measures  may  be  alternated.  After  the  bath 
reaction  is  favored  by  a  warm  room,  hot  enema,  hot  drink,  friction 
with  a  crash  towel  or  warm  hand.  Especial  care  should  be  paid 
to  the  legs  and  feet.  A  sheet  should  cover  the  patient  as  soon  as 
reaction  is  secured  to  prevent  evaporation  of  the  moisture  upon  the 
skin  surface  that  succeeds  reaction. 

There  are  individuals — but  very  few,  indeed — who  do  not  react 
well,  and  who  require  careful  application  of  hydriatic  procedures,  but 
a  thorough  knowledge  of  physiological  conditions  and  technique  will 
enable  the  hydriatist  to  educate  his  patients  to  react  promptly  and  to 


52  PRACTICAL  HYDROTHERAPY. 

the  fullest  degree.  It  is  the  author's  invariable  rule  to  require  patients 
who  are  ambulatory  to  assist  in  rubbing  themselves,  not,  as  is  generally 
supposed,  to  relieve  the  attendant,  but  to  favor  and  stimulate  reaction. 
Muscular  movement,  therefore,  becomes  one  of  the  means  of  pro- 
ducing this  condition. 

An  atonic  reaction  follows  after  the  prolonged  immersion  of  the 
body  in  cold  water,  even  where  an  endeavor  has  been  made  to  suppress 
reaction  by  avoiding  great  cold  or  percussory  measures,  as  in  the  cool 
and  cold  full  bath.  This,  of  course,  is  the  object  sought  in  those 
applications  that  are  antipyretic,  or  baths  used  in  typhoid  fever,  such 
as  that  of  Brand.  It  should  never  be  forgotten  that  it  is  the  physician's 
duty  to  study  his  patient  so  that,  especially  at  the  start,  he  will  not 
apply  a  stimulant  that  will  exceed  the  powers  of  response.  I  take  it 
that  it  is  the  essential  keynote  of  every  form  of  systemic  hydrotherapy 
that  perfect  reaction  is  the  object  aimed  at,  and  that  unless  this  is 
secured  the  benefit  is  lost.  The  author  does  not  believe  in  the  admin- 
istration of  narcotic  poisons,  such  as  alcohol,  to  prevent  (?)  shock. 
They  are  in  themselves  semi-antagonistic  to  reaction,  and  in  febrile 
states  add  to  the  toxemia  present.  A  failure  to  react  is  an  exceedingly 
unpleasant  condition,  is  usually  accompanied  by  faintness,  weakness, 
chilliness,  cold  extremities,  pale  cold  skin,  oppression,  depression, 
lassitude,  vertigo  and  headache.  It  is  an  evidence  that  the  bath  has 
been  too  much  for  the  vital  activities.  Over-reaction  or  stimulation 
is  attended  by  excitement,  fullness  of  the  head,  headache  and  rapid 
heart  action.  Where  reaction  fails  it  is  a  sign  to  make  the  application 
shorter,  colder,  increase  mechanical  percussion  and  prepare  the  patient 
both  before  and  after.  Over-reaction  requires  cooling,  non-mechan- 
ical measures  at  temperatures  between  70°  and  80°  F.  Kellogg13  has 
tabulated  these  reactions  as  follows : 

Cold. 

ACTION.  REACTION. 

1.  Contraction    of    the    small    blood-  1.  Dilatation     of     the     small    blood- 
vessels of  the  skin,  with  dilatation  of       vessels    of    the    surface,    with   contrac- 

internal    vessels    after    a    very    brief  tion  of  the  internal  vessels, 
contraction. 

2.  Pallor  of  the  skin.  2.  Redness  of  the  skin. 

3.  Goose  flesh  appearance  and  rough-  3.  Skin  soft,  smooth  and  supple, 
ness  of  the  skin. 

4.  Sensation    of    chilliness.  4.  Sensation   of   warmth. 

5.  Trembling,    shivering,    chattering  5.  A  sensation  of  comfort  and  well- 
of  the   teeth,   in   some   cases   decidedly  being. 

painful    and    distressing   sensations    of 
"constriction,"  etc. 

6.  First  quickening,  then  slowing  of  6.  Slowing    of    the    pulse,    with    in- 
the  pulse,  with  increase  of  tension.            creased  tension. 

13  Kellogg,    J.    EL:    "Rational   Hydrotherapy,"    1906,   p.    131. 


PHYSIOLOGICAL  ACTION  OF  WATER.  53 

7.  First    checked,    then   quick,   deep,  7.  Respiration      free,      slower     and 
gasping  respiration.  deeper. 

8.  Cooling  of  the  skin.  8.  Heating  of  the  skin. 

9.  In    most    cases    slight    rise    of    in-  9.  Fall   of   internal   temperature. 
ternal  temperature. 

10.  Perspiration    checked.  10.   Increase    of    perspiration. 

Reaction  is,  then,  dependent  upon  the  vital  capacity  of  the  patient 
to  respond,  upon  the  general  systemic  condition,  preparatory  training, 
habit  of  using  cold  water,  the  temperature  of  the  water,  mechanical 
effects,  duration  of  treatment,  psycho-neural  state,  prior  and  past 
preparation. 

Contraindications. 

There  are  really  few  contraindications  to  the  use  of  hydrotherapy. 
Certain  conditions  would  lead  to  caution  and  care,  but  a  physician  in 
full  possession  of  the  physical  and  neural  state  of  his  patient  should 
have  no  difficulty  in  adopting  hydriatics  to  the  case  in  hand  He  will 
always  remember  that  it  is  not  the  disease  he  is  treating,  but  the 
patient  that  demands  his  therapeutic  ministration.  The  extremes  of 
life — old  age  and  infancy — require  judgment  in  the  case  of  hydriatics. 
We  can,  however,  by  carefully,  cautiously  and  slowly  training  the 
reactive  powers,  develop  their  power  to  respond  to  thermic  stimuli  of 
considerable  strength,  avoiding,  therefore,  very  hot  and  very  cold 
baths  even  after  considerable  training.  Fatigue  and  exhaustion  con- 
traindicate  cold  baths,  but  this  can  be  overcome  by  a  preliminary  hot 
or  very  hot  application,  succeeded  by  a  very  brief  percussory  cold  one. 
Profuse  perspiration  not  due  to  heat,  accompanied  by  fatigue,  indicates 
warm  applications  and  frequent  drying  of  the  surface  without  friction; 
when  stimulation  has  been  brought  about,  very  brief  general  measures 
may  be  used,  or  portions  of  the  body  rapidly  sponged. 

Rheumatic  and  gouty  people  do  not,  as  a  rule,  stand  cold  well  at  the 
start,  but  must  be  gradually  trained.  Cold  bathing  is  a  good  prevent- 
ative of  the  "diathesis."  A  subnormal  temperature  and  impending 
chill  demand  heating  methods,  and  in  these  the  incandescent  electric 
light  bath  and  superheated  dry  hot  air  are  the  best.  Exotics,  neurotics, 
neurasthenics,  hysterics,  undue  mental  excitability,  etc.,  demand  diplo- 
macy. Cardiac  disease  was  for  years  considered  a  contraindication, 
but  Schott  has  shown  this  to  be  a  fallacy,  and  to-day  we  use  the 
Nauheim  bath  to  compensate  organic  heart  lesions.  Hot  and  very  hot 
baths  are  contraindicated  in  these  diseases,  aneurisms,  or  in  any  ob- 
structive trouble  with  the  circulation.  The  prolonged  warm  bath,  with 
its  devitalizing  and  atonic  effects,  should  never  be  used  save  by  medical 
prescription.  Marked  arterial  disease  and  extreme  debility  contrain- 
dicate  cold  baths.  In  conclusion,  we  may  say  that  good  common  sense 
and  judgment,  and  the  keeping  within  rational  and  temperate  bounds, 
will  prevent  hydriatic  mishaps. 


CHAPTER  IV. 
THE  INTERNAL  USES  OF  WATER. 

Most  of  the  medical  fraternity  appreciate,  in  a  desultory  manner, 
the  value  of  drinking-water,  and  that  it  has  therapeutic  uses ;  but  few 
take  occasion  to  acquaint  themselves  with  the  physiological  action  and 
administer  it  in  a  systematic,  proper  manner.  From  Hippocrates  to 
to-day  the  drinking  of  water  has  possessed  more  or  less  mystical  power, 
and  the  feeling  that  in  "springs"  or  health  spas  there  exists  some 
subtle  power  has  been  shared  by  the  medical  profession.  It  has  always 
suffered  opprobrium  through  empirics,  who,  believing  water  a  useful 
means  to  their  ends,  used  the  same  to  the  discredit  of  the  members 
of  a  learned  profession.  The  physician,  as  a  rule,  has  been  very  lax 
in  his  recommendations  of  waters  supposed  to  possess  certain  marvel- 
ous curative  powers  because  of  the  "naturally  combined"  salts  they 
contain,  the  minute  doses  of  which  are  supposed  to  effect  the  removal 
of  poisons  and  the  restoration  to  health.  In  truth,  it  was  the  water, 
plain  H,0,  and  not  the  mineral.  Gallons  upon  gallons  of  printer's  ink 
have  likewise  aided  its  supposed  "mineral"  value.  We  can  really 
understand  its  universal  bodily  need  when  we  recall  what  Claude 
Bernard  has  said:  "Life  exists  only  in  a  liquid  medium,  it  is  only  by 
certain  artifices  of  construction  that  the  organism  of  man,  as  those  of 
other  animals,  can  live  without  it ;  but  all  the  active  cells  upon  which 
their  functions  depend  live,  without  exceptions,  like  the  infusoria,  in 
a  liquid  medium."  1 

Water  is  one  of  the  prime  necessaries,  its  long-continued  absence 
causing  death.  Man  can  live,  as  did  Dr.  Tanner,  for  forty  days 
without  food,  but  a  very  few  days  of  absolute  deprivation  of  water 
will  cause  death.  When  an  animal  loses  22  per  cent,  of  its  tissue  water 
it  dies,  and  a  10  per  cent,  loss  will  cause  very  grave  disturbances.  It 
ranks  with  air,  heat  and  cold  in  its  influence  upon  the  processes  of 
animal  life.  It  may  act  as  a  food  or  nutrient  agent,  and  as  a  solvent 
of  all  secretions ;  is  a  component  part  of  every  structure,  excretion 
and  secretion  of  the  body;  is  the  great  diluent  by  means  of  which  the 
dissolved  food  material  is  conveyed  to  and  waste  material  from  the 
tissues  to  the  excretory  organs.  Every  cell  and  fiber  of  the  body  is 
kept  moist  and  bathed  by  this  liquid,  and  unless  it  is  present  the 
function  of  the  tissue  is  destroyed.  The  blood  stream  is  made  fluid 
by  its  use;  in  its  presence  more  oxygen  is  absorbed  and  more  carbon 

1    "Etudes   Physiologiques   sur   quelques  Poisons   Americains,"    Paris,    1864. 

(54) 


THE  INTERNAL  USES  OF  WATER.  55 

dioxide  eliminated.  It  is  the  most  grateful  of  all  fluids  for  quenching 
thirst — a  demand  of  the  system  to  equalize  the  water  which  has  been 
consumed  in  the  processes  of  metabolism  or  eliminated  from  the  body. 
It  must  be  borne  in  mind  that  water  does  not  act  in  a  purely  mechan- 
ical capacity,  simply  washing  out  toxins  and  waste  material  of  tissue 
break-down,  but  is  a  true  solvent,  a  powerful  and  vital  stimulant ;  an 
oxidizer  that  promotes  tissue  change,  and  in  its  turn  stimulates  recon- 
struction— in  fact,  acting  as  a  general  rejuvenating  agent  upon  the 
system. 

Abstinence  from  water  withdraws  the  water  from  the  tissues, 
then  increases  the  specific  gravity  of  the  plasma,  reducing  its  solvent 
powers,  and  rendering  nutrition  and  elimination  impossible.  The 
ingestion  of  large  amounts  of  inorganic  salts  increases  thirst  by  raising 
the  specific  gravity  of  the  plasma,  thus  calling  for  more  fluid  to  assist 
in  their  elimination.  In  the  same  way  the  eating  of  large  quantities 
of  proteid  food,  the  end-products  of  which  (urea,  uric  acid,  creatin, 
etc.)  thicken  the  plasma  and  demand  dilution.  Fats  and  carbohy- 
drates, the  terminals  of  which  are  water  and  carbon  dioxide,  do  not 
demand  the  same  amount  of  water  as  proteid,  for  C02  does  not 
increase  the  specific  gravity  of  the  plasma  and  is  eliminated  by  the 
lungs.  Restriction  of  water  increases  toxemia,  does  not  decompose 
fats,  destroys  appetite  and  the  total  food  ingested,  which  may  thus 
cause  reduction  in  weight.  It  is  in  this  connection  interesting  to  note 
that  sugar  and  peptone,  carbon  dioxide  and  urea,  a  product  of  proteid 
oxidation,  have  a  high  degree  of  solubility  in  water.  Uric  acid, 
oxalic  acid  and  other  abnormal  products  are  poorly  soluble,  hence,  as 
has  been  shown  by  Haig,  they  readily  accumulate  in  the  body,  es- 
pecially in  those  portions  in  which  the  circulation  is  least  active. 

An  agent  capable  of  so  much  good  makes  it  of  importance  that  the 
source  of  water  supply  should  be  free  from  all  the  contaminating 
influences  that  arise  from  the  ordinary  pollution  common  in  civilized 
countries.  Rain  washes  out  a  great  deal  of  mineral  and  organic 
matter  from  the  air,  which  is  carried  into  our  lakes  and  streams,  to 
which  must  be  added  the  sewage  from  large  and  small  towns.  A 
heavy  responsibility  rests  upon  civic  authorities  to  secure  a  water 
free  from  the  mechanical  impurities  of  dirt,  mud  and  bacteria, 
as  well  as  from  organic  matter,  and  palatable  to  the  taste,  an  ideal 
water,  difficult  to  secure  under  ordinary  circumstances. 

Its  physiological  action  is  derived  from  the  water  itself,  and  not 
from  any  mineral  contained  therein.  The  effect  of  cold  water  taken 
internally  is  to  refrigerate  the  part  with  which  it  comes  in  contact,  the 
stomach,  like  the  skin,  having  to  overcome  the  impact  of  cold  water 
upon  its  surface  and  bring  about  localized  reaction.  The  mucous  mem- 
brane of  the  stomach  becomes  pale,  the  blood-vessels  and  muscular 
structures  contract.     The  cold  water  lying  in  the  stomach  causes  a 


56  PRACTICAL  HYDROTHERAPY. 

lowering  of  temperature,  a  fact  utilized  in  fevers.  When  introduced 
into  the  stomach  or  rectum  Winternitz  observed  that  the  temperature 
of  both  of  these  structures  was  lowered,  that  the  temperature  of  the 
large  intestine  fell  during  a  period  of  twenty-five  minutes  until  a  re- 
duction of  1.5s  C.  was  reached.  With  the  abstraction  of  heat  the 
temperature  of  the  water  rises  to  the  same  as  that  of  the  surrounding 
viscus,  at  which  time  reaction  sets  in,  the  blood-vessels  dilate  and 
water  is  absorbed,  slowly  from  the  stomach,  rapidly  from  the  intes- 
tines. During  this  period  glandular  action  is  lessened.  The  muscular 
structures  here  as  elsewhere  are  toned  by  the  action  of  cold  upon  them, 
provided  the  quantity  is  not  too  great  to  stretch  the  viscus.  The 
contents  of  the  stomach  and  bowels  are  diluted  by  its  local  action. 
When  reaction  takes  place  the  blood-stream  is  diluted  and  flushed  by 
its  presence.  Reflexly,  the  heart's  action  is  slowed,  the  pulse  fuller 
and  less  frequent,  with  raised  arterial  tension,  easily  shown  by  the 
sphygmanometer  and  felt  by  the  finger.  If  a  fairly  large  quantity — 
half  to  one  quart — be  ingested,  there  may  be  a  fall  of  from  ten  to 
twenty  beats,  lasting  for  ten  or  fifteen  minutes,  according  to  my  ob- 
servation. It  has  been  pointed  out  by  Winternitz2  that  the  influence 
of  the  drinking  of  large  quantities  (quart)  of  cold  water  tends  to 
produce  a  contraction  of  peripheral  blood-vessels,  and  that  its  inges- 
tion reacts  upon  the  temperature  of  the  entire  body.  The  effect  upon 
the  pulse  and  circulation  is  due  to  the  direct  stimulation  of  the  fila- 
ments of  the  pneumogastric  and  sympathetic  nerves  and  the  accom- 
panying reflex  action. 

The  excretion  of  water  falls  more  directly  upon  the  heart  than 
would  at  first  be  supposed;  therefore  the  greater  the  amount  intro- 
duced the  greater  the  cardiac  labor,  just  as  would  be  the  case  with 
a  force-pump.  Weak  hearts  and  weak  kidneys  are  strained  by  tco 
great  volume  of  water,  weakening  the  former,  irritating  the  latter. 
In  fact,  abstention  from  water  diminishes  the  total  labor  performed 
by  the  circulatory  apparatus,  and  thus  spares  the  heart. 

Their  rapidity  of  action  shows  them  to  be  of  reflex  origin.  The 
rapid  drinking  of  cold  water  increases  temporarily  respiration,  but 
this  quickly  subsides.  The  free  ingestion  of  water,  like  its  applica- 
tion upon  the  external  surface,  favors  the  absorption  of  oxygen  and 
the  elimination  of  C02.  Upon  the  blood  and  lymph  it  acts  as  a  dilu- 
ent where  it  is  continuously  drunk,  although  it  may  be  so  imbibed  as 
to  increase  or  dimish  its  fluidity. 

As  a  diluent  it  favors  the  suspension  of  the  corpuscles  and  the 
solution  of  the  albumins  and  globulins,  effete  material  and  inorganic 
salts  that  increase  the  solvent  power  of  the  plasma. 

Bocker  has  pointed  out  that  immediately  after  the  ingestion  of 
considerable  water,  this  increased  amount  is  present  in  the  blood,  but 

2  Winternitz,    Wm. :    "Ziemssen's    Cyclopedia    of   Therapeutics,"    Vol.    IX,    Hydrotherapy. 


THE  INTERNAL  USES  OF  WATER.  57 

shortly  after  this  the  blood  becomes  thicker  and  more  condensed, 
showing  that  the  water  has  entered  the  tissues.  The  absorption  of 
water  probably  takes  place  through  the  veins  of  the  stomach  and  in- 
testines, and  the  rate  at  which  it  is  absorbed  in  health  depends  some- 
what upon  its  alkalinity  and  freedom  from  minerals,  the  presence  of 
carbon  dioxide  gas  being  a  stimulant  to  the  vascular  system  to  take  up 
more  rapidly  the  fluids  contained  in  these  viscera.  It  has  been  esti- 
mated that  10  per  cent,  of  the  water  ingested  is  absorbed  from  the 
stomach  and  90  per  cent,  from  the  intestines. 

It  is  a  well-known  fact  among  clinicians  that  the  reasonable  inges- 
tion of  water  favors  digestive  processes  and  assimilation.  Not  only 
does  it  favor  absorption,  but  it  becomes  a  medium  by  which  the  diges- 
tive pabulum  is  conveyed  more  rapidly  to  the  tissues  and  nutritive 
exchange  brought  about.  The  writer  has  not  only  observed,  but  has 
had  a  number  of  people  call  his  attention  to  the  fact,  that  a  patient 
eating  the  same  amount  of  food  with  an  increased  supply  of  water  in- 
ternally is  apt  to  gain  in  body  weight,  which  has  led  to  the  populariza- 
tion of  the  idea  that  water-drinking  produces  fat  and  tissue  forma- 
tion, a  fact  that  is  borne  out  upon  investigation.  Glandular  structures 
are  stimulated,  as  is  the  digestive  process,  the  intestinal  juices  and 
peristalsis.  A  larger  and  freer  flow  of  bile  occurs  from  the  common 
duct,  less  tenacious  in  character  and  capable  of  more  pronounced  in- 
fluence in  its  digestive  and  antiseptic  functions.  The  blood  of  the 
portal  vein  being  diluted,  this  large  glandular  organ  eliminates  more 
toxins  and  waste  products.  Its  action  upon  the  muscular  and  secre- 
tory portions  of  the  gastro-intestinal  tract  and  liver  is  one  of  the  ex- 
planations of  why  increased  drinking  of  cold  water  overcomes  habitual 
constipation.  With  the  blood  recharged  with  oxygen,  more  fluid  in 
character,  anabolic  and  katabolic  processes  are  facilitated,  and  waste 
products  of  tissue  change  in  the  presence  of  this  oxidizing  agent  dis- 
appear; there  is  a  general  revivifying  and  rejuvenating  influence,  a 
baptism  that  literally  makes  the  tissue  born  again.  The  human  body 
becomes  stagnated,  its  processes  inactive,  its  secretion  lessened,  its 
excretion  diminished,  its  nervous  system  more  sensitive,  when  the 
body  is  not  supplied  with  sufficient  water,  and  reasonable  ingestion  is 
apt  to  insure  increased  activities  in  these  directions.  It  is  a  well- 
known  fact  that  where  the  body  has  been  robbed  of  fluids,  as  in  loss 
of  blood,  severe  diarrhea,  etc.,  there  is  increased  thirst  and  desire  for 
more  water.  It  acts  as  a  diuretic,  increasing  the  watery  and  solid 
constituents  of  the  urine,  lessening  nitrogenous  tissue  waste.  Oxalic 
acid,  sulphates,  the  so-called  uro-toxic  group  and  extractives  are  con- 
sumed. 

It  has  been  found  by  Hawk3  that  copious  water  drinking  increased 
the  excretion  of  nitrogen  and  phosphorus  by  the  urine,  the   former 

3  Uuiversity  of  Pennsylvania  Medical  Bulletin,  1905. 


58  PRACTICAL  HYDROTHERAPY. 

due  to  washing  out  of  the  tissues  of  urea  previously  formed  but  which 
has  not  been  removed  by  normal  processes.  Katabolic  proteid  pro- 
cesses being  likewise  stimulated,  there  is  increased  urea  formed.  The 
greater  phosphorus  elimination  resulted  from  the  increased  activity 
of  the  cellular  structures  of  the  body  and  the  katabolism  of  nucleins, 
lecithins  and  other  phosphorus-containing  bodies.  Maximum  excre- 
tion occurred  with  absolute  regularity  on  second  day  of  water  in- 
gested, while  fluid  excretion  was  greatest  on  days  of  copious  drink- 
ing. In  like  manner  Heihner,4  experimenting  upon  dogs,  came  to 
the  conclusion  that  the  increased  nitrogen  was  largely  due  to  a  more 
active  katabolism  in  the  body  of  organic  material. 

Cold  water  should  be  only  drunk  in  small  quantities  immediately 
before,  during  or  for  an  hour  after  meals,  for  when  taken  cold  into 
the  stomach  during  the  process  of  digestion  it  chills,  diminishes  the 
secretion  of  both  hydrochloric  acid  and  pepsin,  as  well  as  diluting  the 
gastric  juice.  The  ingestion  of  large  quantities  of  water,  especially 
at  meals,  is  to  increase  the  appetite.  It  may  produce  a  lack  of  mo- 
tility and  subsequent  digestive  disturbances.  It  should  be  especially 
avoided  by  those  who  have  a  dilated  stomach.  Like  everything  else, 
water  must  be  administered  with  the  object  in  view,  and  upon  rational 
consideration  of  its  physiological  effect.  If  it  is  taken  in  too  large 
quantities,  and  its  use  prolonged,  it  is  apt  to  interfere  with  tissue 
change  and  promote  disintegration.  It  is  best  administered  at  50°  to 
60°  F.,  from  one  to  two  hours  after  to  thirty  minutes  before  meals, 
during  which  time  the  patient  can  drink  from  six  to  eight  ounces 
every  half  to  one  hour.  In  this  way  the  tissues  become  saturated, 
and  physiological  effects  are  obtained. 

Hot  Water. 

The  physiological  action  of  hot  water,  taken  internally,  is  similar 
to  the  action  of  this  agent  externally — that  is  to  say,  it  tends  to  pro- 
duce an  atonic  condition  of  the  structures  with  which  it  is  brought 
in  contact.  The  digestive  system  is  relaxed,  its  juices  diluted,  the 
muscular  and  secretory  functions  weakened.  The  empty  viscus  is 
cleansed,  and  mucus  and  particles  of  food  adherent  to  the  stomach  walls 
removed.  The  thermic  impressions  are  conveyed  to  centers  in  the  cord 
and  medulla,  increased  heat  absorption  takes  place ;  the  system,  in  its 
endeavor  to  equalize  this,  dilates  the  peripheral  blood-vessels,  per- 
spiration is  induced  and  heat  lost.  It  increases  the  heart  action  ten 
to  fifteen  beats  per  minute.  After  the  water  is  absorbed  its  general 
action  is  similar  to  that  of  cold  water,  which  has  been  described  above. 

Hot  water  drinking  is  now  a  popular  fad  with  the  laity.  There 
is  no  question  but  what,  in  some  forms  of  gastritis,  where  there  is  a 

4  Heihner,  E. :  Zeitschrift  f.  exper.  Path.  u.  Therapie,  Vol.  47,  p.  538,  1906. 


THE  INTERNAL  USES  OF  WATER.  59 

large  accumulation  of  mucus  in  the  stomach,  the  drinking  of  hot  water, 
by  removing  this  tenacious  mass,  favors  the  digestion  of  food.  There 
are,  however,  many  objections  to  its  use  even  in  these  cases. 

Its  physiological  action  is  similar  to  the  foundation  of  all  hydro- 
therapeutic  applications  of  water,  viz.,  that  hot  water  acts  as  an  atonic 
agent,  relaxing,  depressing,  debilitating;  while  cold  water  is  tonic  and 
stimulating  to  all  structures  with  which  it  comes  in  contact. 

Therapeutics. 

The  purest  water  is  that  which  has  been  freed  by  distillation  from 
all  organic  and  mechanical  impurities.  This  water,  being  deprived  of 
air,  has  a  disagreeable  or  "flat"  taste,  that  can  be  obviated  by  the 
introduction  of  new  air  into  the  water.  A  simple  way  of  doing  so  is 
to  half  fill  a  gallon  bottle  with  distilled  water,  cork  tightly,  and  place 
in  a  refrigerator  until  chilled,  after  which  the  bottle  is  to  be  agi- 
tated, whereupon  the  water  absorbs  the  air  and  becomes  palatable  to 
the  taste.  By  far  the  most  pleasant  beverage,  both  for  general,  hy- 
gienic and  therapeutic  use,  however,  is  a  distilled  water  at  70°  to 
60°  F.  that  has  been  carbonated — that  is  to  say,  charged  with  carbon 
dioxide.  This  water  is  pure  and  has  a  "snap"  that  makes  it  palatable.  A 
secondary  consideration  is  the  fact  that  carbonated  water  is  more  read- 
ily and  quickly  absorbed  from  the  mucous  membrane  of  the  stomach, 
and  for  this  reason  the  author  has  never  seen  any  harm  result  from 
the  moderate  drinking  of  soda-water,  provided  a  pure  fruit  juice  is 
used  in  connection  with  ice  and  carbonated  water,  although  he  is 
distinctly  opposed  to  the  use  of  this  drink  with  ice  cream. 

There  is  a  charm  about  effervescence  that  is  fascinating  to  most 
people.  Natural  effervescent  or  "sparkling"  waters  have  always  held 
a  popular  place,  but  have  of  late  been  displaced  by  the  easier  made 
artificial  product.  The  carbonated  and  bubbling  water  possesses  a 
mild  stimulating  property,  singularly  attractive  to  the  average  palate. 
In  reasonable  quantities  the  aerated  water  is  without  prejudice  to 
health.  Its  physiological  action  is  obtained  from  the  water  itself,  and 
not  from  the  mineral  contained  therein.  Certain  waters  possess  thera- 
peutic value  because  of  their  minerals,  particularly  the  sulphates,  but 
the  good  derived  from  ordinary  mineral  spring  zvater  can  be  obtained 
from  the  use  of  plain  water,  if  drunk  in  sufficient  quantities.  There 
are  many  disadvantages  in  the  ordinary  mineral  water,  absorption 
being  lessened  and  made  more  difficult  the  greater  the  amount  of 
mineral  matter  it  contains.  It  may  be  an  Hibemianism  to  say  that  the 
best  mineral  water  is  the  water  that  contains  no  mineral,  but  this, 
nevertheless,  is  a  truism.  Too  often  value  is  credited  to  mineral 
springs  which  in  reality  they  do  not  deserve ;  for  it  is  from  the  rest, 
change  of  diet,  freedom  from  care  and  worry,  and  the  ingestion  of 
large  quantities  of  liquid  containing  a  small  or  medium   amount  of 


60  PRACTICAL  HYDROTHERAPY. 

mineral  that  results  are  obtained.  It  is  likely  that  better  results  would 
have  been  obtained  if  they  had  used  the  water  without  any  mineral, 
but  simply  carbonated.  Frequently  harm  is  done  at  springs  by  the 
endeavor  to  secure  full  monetary  returns  by  drinking  too  freely  of  the 
water,  and  this  also  is  the  danger  in  its  empiric  use  by  the  charlatan. 
The  amount  of  water  that  the  average  healthy  individual  should  drink 
ranges  from  six  to  eight  glasses  in  twenty-four  hours.  In  diseased 
states  it  is  a  question  for  the  discrimination  and  discretion  of  the 
attending  physician,  who  will  prescribe  it  upon  the  full  knowledge 
of  its  physiological  action  and  the  needs  of  his  patient.  In  febrile 
states  patients  should  be  systematically  given  cold  water,  for  it  is  an 
antithermic  agent,  stimulates  all  the  excretory  organs,  especially  the 
liver,  destroys  and  eliminates  toxins,  leucomaines,  ptomaines,  etc. 
If  free  perspiration  can  be  produced  the  temperature  will  be  reduced. 

Debove,  practicing  Brand's  method  in  typhoid  fever,  gives  six 
ounces  of  cold  water  every  two  or  three  hours  as  a  means  of  stimu- 
lating the  excretion  of  the  typhoid  toxins.  The  urine  frequently  rises 
under  water  drinking  to  twice  the  normal,  even  in  febrile  states. 
Winternitz  has  suggested  two  simple  processes  by  means  of  which  to 
regulate  the  quantity  of  water  the  system  should  take  to  increase 
the  fluid  in  the  tissues,  or  to  cause  effusions  to  be  absorbed.  If  it 
is  desired  to  flood  the  tissues,  small  quantities  should  be  taken  at  fre- 
quent intervals ;  to  stimulate  absorption  and  remove  serous  exudates, 
administer  a  reasonable  amount  of  fluid  followed  by  a  considerable 
period  of  abstinence,  say  once  every  twelve  hours.  He  has  secured 
excellent  results  in  dropsy  by  so  doing. 

As  before  stated,  the  free  drinking  of  cold  water  stimulates  the 
entire  digestive  tract,  and  removes  one  of  the  banes  of  modern  civi- 
lized life,  constipation,  when  this  is  due  to  simple  causes.  Two  glasses 
may  be  taken  before  breakfast  at  40°  to  50°  F.  All  persons  afflicted 
with  rheumatism,  gout,  uric  acid  and  its  allied  toxins,  should  drink 
freely  of  water  in  such  manner  as  to  flood  the  tissues,  favoring  oxi- 
dative processes.  The  dry,  inactive,  scaly  or  greasy  skin  is  much  ben- 
efited by  having  its  tissues  freely  drenched  with  water.  This  is  facil- 
itated by  external  applications,  followed  by  good  reaction — in  fact, 
all  conditions  pointing  toward  a  free  ingestion  of  water  internally 
likewise  point  to  its  use  externally. 

In  diseases  of  the  liver  water  should  be  drunk  liberally,  ten  to 
twelve  glasses  daily,  not  only  with  a  view  of  eliminating  those  crys- 
tallized substances  likely  to  produce  gall-stones,  but  to  liquefy  the  blood 
in  the  portal  vein,  and  thus  favor  the  solution  and  elimination  of  intes- 
tinal as  well  as  systemic  poisons.  By  its  introduction  into  the  intes- 
tinal canal  many  of  these  poisons  are  oxidized  and  never  reach  the 
portal  circulation.  It  is  a  fact,  well  known  even  to  the  laity,  that  the 
habitual  drunkard,  the  periodic  spreer,  the  morphine  fiend — in   fact. 


THE  I  NT  URN  AL  USES  OF  WATER.  61 

any  one  addicted  to  the  use  of  a  drug — can,  to  a  certain  extent,  re- 
duce the  amount  taken  and  diminish  its  evil  influence  by  free  water 
drinking.  Diuresis  may  he  induced  by  large  quantities  of  cold  water, 
raising,  as  it  does,  the  blood-pressure  in  the  kidney. 

It  should  be  borne  in  mind  that  cold  water  drinking  is  contra- 
indicated  when  one  is  very  much  fatigued,  whether  the  skin  be  active 
or  inactive,  for  shock  and  collapse  may  be  thus  produced.  Hot  water 
has  very  little  use  in  internal  therapeutics,  liy  its  mechanical  help  in 
removing  mucus,  it  is  useful  in  chronic  gastric  catarrh,  being  drunk 
one  hour  before  meals  at  a  temperature  as  hot  as  can  be  borne — so 
hot,  in  fact,  that  it  should  be  sipped  with  a  spoon.  The  object  in  drink- 
ing this  an  hour  before  meals  is  to  permit  of  the  stomach's  returning 
to  a  normal  condition  before  food  is  taken.  It  debilitates  the  entire 
digestive  system.  Its  use  is  particularly  pernicious  in  those  cases 
who  have  an  atonic  or  dilated  stomach.  Nearly  all  secretory  dis- 
turbances are  aggravated  by  its  use  except  hyperpepsia,  in  which  the 
amount  of  gastric  juice  is  lessened.  In  some  instances  patients  have 
received  temporary  benefit  from  the  use  of  very  hot  water  in  neu- 
ralgic states  of  the  stomach  and  bowel,  possibly  due  to  the  removal 
of  fermenting  material  and  the  relief  of  spasmodic  conditions  pres- 
ent. It  relieves  colic  in  a  similar  manner.  We  may  provoke  emesis  or 
vomiting  by  means  of  the  copious  use  of  water  ranging  from  94°  to  96° 
F.  The  author  does  not  at  all  believe  in  the  provoking  of  emesis,  but 
much  prefers  the  use  of  the  stomach-tube,  as  by  that  means  he  is  cer- 
tain of  not  only  removing  the  stomach  contents,  but  of  knowing  that 
the  viscus  is  clean.  Drinking  water  at  meals  must  be  avoided,  save 
in  small  amounts. 


CHAPTER    V. 

ASSOCIATED  PROCEDURES. 

The  hydrotherapeutist,  in  the  practice  of  his  science  and  art,  calls 
into  play  certain  procedures  that  are  of  themselves  not  truly  hydrothera- 
peutic,  but  which  have  been  for  years  indelibly  associated  with  his 
work.  For  this  reason  we  find  them  described  in  books  upon  this  sub- 
ject; they  form  one  of  the  essential  means  he  has  at  command  for 
obtaining  results,  and  have  by  courtesy,  so  to  speak,  been  relegated  to 
this  branch  of  medical  practice.  I  have  called  them,  because  of  their 
peculiar  relation,  "Associated  Procedures,"  and  will  consider  under 
this  head,  sunlight,  incandescent  electric  light  bath,  arc  light  bath, 
hot  air,  superheated  dry  hot  air,  vapor  of  steam,  etc.  Some  of  these 
have  been  known  for  years,  and  were  even  utilized  by  the  ancients 
for  the  preservation  of  health  and  the  treatment  of  disease,  while 
others  are  of  modern  growth,  brought  about  by  advances  and  im- 
provement   in    electrical    apparatus. 

Sunlight. 

The  finite  human  mind  has  difficulty  in  grasping  the  rate  at  which 
light  travels,  about  186,000  miles  per  second,  but  this  dwindles  into 
insignificance  before  an  appreciation  of  the  varying  wave-lengths  of 
the  visible  colors,  which  have  been  roughly  estimated  at  one-half  to 
two  trillion.  Light  varies  as  to  speed  and  wave-lengths,  the  division 
into  heat,  light  and  chemical  rays  being  purely  relative,  one  class 
merging  into  the  other.  Light  waves  are  of  shorter  length  than  heat 
waves,  but  are  capable  of  producing  heat  if  they  fall  on  a  suitable  ob- 
ject, and  meet  resistance.  It  is  said  that  no  substance  permits  all  the 
rays  to  pass  through  it,  and  that  no  substance  is  capable  of  keeping 
them  all  out.  The  blue,  violet  and  ultra-violet  rays  produce  certain 
chemical  changes  of  value,  and  are  considered  true  actinic  light.  Bis 
calculated  that  with  100  as  a  standard  the  effects  of  light  are,  chemical 
96,  other  radiations  4,  and  says  that  at  the  present  time  it  is  impossible 
to  state,  exactly,  the  action  of  light.  These  chemical  rays  act  on  silver 
salts,  are  absorbed  by  glass,  but  pass  readily  through  quartz,  rock 
crystal  and  Iceland  spar.  Recent  investigations  seem  to  show  that 
rays  of  every  wave-length,  from  one  end  of  the  spectrum  to  the  other, 
are  capable  of  exerting  some  chemical  actions.  Light  is  a  stimulant 
to  both  vegetable  and  animal  life.    The  luminous  rays  are  found  mostly 

'       (62) 


Plate  16a — Indoor  Sun  Bath   (Kellogg). 


ASSOCIATED  PROCEDURES.  63 

in  the  central  portion  of  the  spectrum,  while  the  heat  rays  lie  in  the 
lower  end.  The  human  body  is  translucent  to  these  rays.  If  we  hold 
the  fingers  over  a  powerful  light,  or  introduce  it  into  the  cavities  of 
the  body,  the  intervening  tissues  glow  and  appear  as  a  beautiful  red 
body,  this  effect  being  known  as  translumination. 

Physiological  Action  of  Light. 

Upon  bacteria,  sunlight  and  the  radiations   from  the  arc  are  de- 
structive, especially  to  lower  forms,  its  action  being  more  active  in  the 
presence  of  oxygen,  and  largely  in  proportion  to  the  number  of  ultra- 
violet rays.     Light  is,   in    fact,   a  disinfectant,  killing  even  tubercle 
bacilli  in  a  few  hours,  especially  if  the  sputum  is  dry.     Light  serves  to 
maintain  health  by  increasing  sanitation.     The  fact  that  sunlight  will 
kill  many  dangerous  bacteria  is  made  use  of  by  engineers  in  purifying 
the  water  supply  of  large  cities.    It  disinfects  and  destroys  both  patho- 
genic and  putrefactive  organisms,  and  prevents  in  the  human  bacterial 
and  other  diseases  by  increasing  both  red  and  white  blood  corpuscles. 
The  whole  human  organism  reacts  and  responds  to  the  influence  of  light. 
Upon  the  skin  strong  sunlight  acts  as  an  irritant,  producing  the  solar 
erythema,  a  dermatitis,  ordinarily  designated  "sun  burn,"  causing  it 
to  become  red,  to  swell,  sting  and  pain.     Blisters  may  be  formed,  and, 
where  the  exposure  is  continued,  necrosis  may  take  place.     Usually, 
however,  the  swelling  goes  down,  the  redness  diminishes,  the  blisters 
dry  up  and  desquamation  occurs.     Changes  similar  in  character  take 
place  under  the  action  of  the  arc  light,  several  observers  having  re- 
corded the  production  of  an  erythema  where  an  electric  welding  is 
done.     Where  the  exposure  is  continued,  deep  pigmentation  follows, 
serving  as  a  barrier  to  further  penetration  and  action  in  an  inflam- 
matory manner.    This  is  known  as  "tanning,"  and  is  believed  to  result 
from  a  destruction  of  red  blood  corpuscles,  followed  by  a  deposit  of 
their  pigment  in  the  skin,  nature  thereby  protecting  the  delicate  struc- 
tures of  the  deeper  layers  of  the  corium.     Sunlight  quickly  produces 
profuse  perspiration,  much  more  so  than  an  equal  temperature  acting 
slowly  by  conduction.     The  cutaneous  blood-vessels  dilate,  there  is  an 
increased  quantity  of  blood  brought  to  the  surface,  resulting  in  active 
stimulation  of  the  sweat  and  sebaceous  glands,  followed  by  profuse 
perspiration.     This  is  likewise  true  of  those  artificial  measures  simu- 
lating sunshine.    The  thermic  impressions  made  upon  the  skin  are  con- 
veyed to  the  spinal  cord,  medulla  and  higher  heat  centers  in  these  or- 
gans and  the  brain,  accelerating  the  heart's  action.     With  perspiration 
heat  loss  takes  place. 

In  a  clear  atmosphere  the  effect  of  sunlight  is  intensified.  In  Egypt 
the  natives,  especially  the  Arabs,  protect  their  heads  from  the  rays 
of  the  midday  sun  by  means  of  large  turbans,  which  form  a  huge  mass, 


64  PRACTICAL  HYDROTHERAPY. 

the  heat  of  which  would  doubtless  be  intolerable  were  it  not  for  the 
relief  afforded  by  the  exclusion  of  the  exciting  actinic  ray. 

A  common  observation  of  the  influence  of  sunlight  upon  the  skin 
may  be  noted  in  the  difference  in  appearance  between  those  who  are 
daily  exposed  to  it  and  fresh  air  and  those  who  are  confined  within 
doors,  particularly  in  illy-ventilated,  dark  offices,  working  by  gas  and 
other  artificial  lights.  In  the  former  instance,  as  exhibited  by  the 
farmer  and  seamen,  we  find  the  ruddy  and  tanned  skin ;  in  the  latter, 
as  exhibited  by  the  bookkeeper,  a  pale  and  sallow  one. 

Upon  the  nervous  system,  light  energy  has  a  stimulating  and  buoy- 
ing influence,  speaking  in  general  terms.  The  spirits  of  mankind  be- 
come more  cheerful  and  lively  under  the  influence  of  sunlight,  and 
cerebral  activity  is  stimulated.  The  different  colors  of  the  spectrum 
are  believed  to  produce  certain  effects  upon  the  central  nervous  sys- 
tem, blue  being  described  as  cold,  green  as  restful,  yellow  as  cheerful, 
red  as  warm,  while  Goethe  says,  "Red  and  yellow  are  bracing,  green 
and  blue  depressing."  Blue  is  believed  to  quiet  cerebral  action,  and 
violet  to  cause  sadness — it  being  one  of  the  accepted  emblems  of  grief. 
Juettner  calls  attention  to  the  fact  that  red  is  a  nerve  stimulant  par 
excellence,  acting  upon  the  sympathetic  nervous  system,  and  through 
this  upon  all  vegetable  and  more  especially  the  animal  functions.  It 
has  ever  been  the  color  of  passion  and  love,  sexuality  being  affected 
by  it.  and  it  was  supposedly  for  this  reason  that  the  lights,  gowns 
and  furnishings  of  the  shrines  of  Venus  were  of  this  shade.  What 
was  true  of  the  older  nations  is  equally  true  of  the  modern  ones,  and 
the  rules  and  promptings  that  guided  them  in  the  selection  of  this  color 
are  still  in  practical  effect  in  modern  life  to-day. 

It  is  evident  that  there  can  be  no  persistent  vitality  nor  healthfully 
developed  bodily  structure  without  light.  If  it  were  possible  for  a 
human  being  to  be  placed  during  the  natural  term  of  his  existence  in  a 
position  of  perfect  darkness,  the  physical  tissues  and  mental  faculties 
would  undergo  serious  modifications  and  degeneration.  Where  light 
is  not  permitted  to  permeate,  there  are  found  bodily  deformities,  intel- 
lectual deterioration,  crime,  disease,  early  and  often  sudden  death.  A 
material  as  well  as  a  moral  and  mental  etiolation  occurs  when  the 
vital  stimulus  of  light  is  withdrawn. 

Compare  the  bright,  happy  faces  and  buoyant  spirits  of  those  who 
reside  in  the  country,  work  in  the  open  fields,  and  upon  whom  the  sun 
is  generally  shining,  with  the  pale,  phlegmatic  faces,  emaciated  forms 
and  nervous  depression  of  those  whose  vocation  in  life  deprives  them 
of  the  health-giving  and  beneficial  influence  of  light.  These  patho- 
logical phenomena  are  observed  among  those  confined  in  dark  places, 
such  as  holds  of  ships,  badly  constructed  houses,  cellars,  prisons,  and 
wherever  light  has  difficulty  in  penetrating. 

The  same  conditions  are  found  in  the  dwellings  of  the  poor  in  large 


M        »        \ 


r- 


SSOCIATED  PROCEDURES.  65 

cities,  where  the  light  which  finds  its  way  through  the  narrow  and 
crowded   streets  is  reflected. 

The  exclusion  from  light  is  well  known  to  produce  organic  altera- 
tions in  the  visual  organs  of  animals,  such  as  atrophy  of  the  optic 
nerve  or  those  portions  of  the  brain  more  immediately  associated  with 
sight.  It  is  supposed  that  the  blindness  observed  among  fish  found  in 
dark  caves  arises  from  the  arrest  in  the  development  of  the  eyes,  as  a 
result  of  a  constant  deprivation  of  light. 

The  corpuscular  richness  of  the  blood  and  the  hemoglobin  content 
are  raised  by  the  use  of  sunlight  or  the  incandescent  bath,  a  fact  at 
once  observed  by  those  who  will  take  the  trouble  to  make  the  simple 
tests  required.  I  have  observed  another  fact  from  the  use  of  light — 
mostly  incandescent — that  the  red  cells  appear  in  a  fresh  specimen, 
prepared  according  to  the  method  of  Schleip,  to  be  fuller  and  slightly 
larger  than  a  specimen  taken  before  the  test.  This  does  not  apply  to  the 
healthy  individual,  in  whose  cells  no  apparent  change  takes  place. 
The  white  cells  are  in  greater  numbers,  and  I  am  inclined  to  think 
their  activity  is  increased.  Assimilation  and  absorption  are  increased, 
as  is  shown  by  the  gains  in  weight.  This  takes  place  provided  the 
method  used  does  not  produce  too  severe  or  profuse  loss  by  perspira- 
tion. Where  it  is  judiciously  combined  with  tonic  {i.e.,  cold)  hydro- 
therapy, and  adapted  to  the  individual  requirement,  there  are  few,  in- 
deed, who  do  not  add  to  the  body  weight.  Both  animals  and  man  tend 
to  develop  and  their  bodily  functions  increase,  Finsen  remarking  that 
the  violet  rays  are  veritable  promoters  of  life  and  energy.  Bis  has 
noted  the  orientation  of  animals  toward  the  light.  Strasser  observed 
that  "an  animal  eliminated  more  C02  under  the  influence  of  light  than 
when  confined  in  the  dark,  and  that  a  starving  animal  loses  less  weight 
at  night  than  during  the  same  number  of  hours  during  the  daylight. 
Eggs  develop  more  rapidly  when  exposed  to  the  influence  of  sunlight 
than  when  kept  in  the  dark.  This  is  also  true  of  the  larvae  of 
insects." 

Under  the  influence  of  natural  light — sunlight — muscular  struc- 
tures are  greatly  strenghtened,  a  fact  that  has  been  noted  by  Petten- 
kofer,  Voigt  and  others.  With  the  added  absorption  of  oxygen,  pro- 
teid  in  the  tissues  is  consumed,  both  by  actual  oxidation  and  by  raising 
the  temperature  of  the  blood. 

The  best  results  are  obtained  when  the  body  is  nude.  Civilization 
has  ordained  the  encompassing  of  man's  cutaneous  surface  in  a  vast 
paraphernalia  of  clothing,  so  that  special  preparation  must  be  made 
so  as  to  meet  ''nature's  requirements,"  and  yet  conform  to  ethics  and 
morality.  This  ideal  state  of  affairs  has  been  secured  by  Kellogg.1 
His  "open  air  gymnasiium"  is: 

1  Kellogg,  J.   H.:     "Rational  Hydrotherapy,"  p.  960.    . 


66  PRACTICAL  HYDROTHERAPY. 

"A  high-walled  enclosure  provided  with  dressing-rooms  and  all 
necessary  conveniences  for  out-of-door  exercises  at  all  seasons  of  the 
year,  consisting  of  the  following:  A  wide  walking  or  running  track 
extending  around  the  outside  of  the  enclosure,  just  one-tenth  of  a  mile 
in  length ;  a  swimming  tank  seventy-five  feet  long,  thirty  feet  wide, 
eight  feet  in  depth  at  one  end  and  three  feet  at  the  other,  with  an  ar- 
rangement for  an  abundant  supply  of  water,  so  as  to  keep  the  con- 
tents of  the  tank  always  fresh  and  clear  and  at  the  proper  tempera- 
ture (from  65°  to  70°);  a  supply  of  wood,  saws,  axes,  and  plenty 
of  material  in  the  shape  of  logs  of  different  sizes,  from  three  inches 
to  three  feet  in  diameter;  a  large  pile  of  white  beach  sand  for  those 
who  wish  to  indulge  in  the  sand  bath ;  swinging  rings,  horizontal  lad- 
ders, a  Maypole,  appliances  for  lawn  tennis,  pitching  quoits,  and 
various  gymnasium  games. 

"On  entering  the  outdoor  gymnasium  the  patient  removes  all  his 
ordinary  clothing  and  dons  a  thin  bathing  suit  or  pair  of  trunks ;  shoes, 
stockings  and  hats  are  discarded,  for  he  desires  to  bring  himself  as 
nearly  as  possible  into  a  state  of  simple  savagery,  and  to  throw  off 
all  the  unwholesome  restraints  of  conventionalism.  A  pair  of  sandals 
may  be  worn  if  desired,  but  it  is  better  to  expose  the  soles  of  the  feet 
to  contact  with  the  earth  and  grass.  He  imagines  himself  a  boy  again, 
frolicking  in  the  freedom  of  unrestrained  activity ;  he  walks,  runs, 
leaps,  rolls  about  on  the  grass,  buries  himself  in  the  sand,  chops  or 
saws  wood,  laughs,  shouts,  whistles,  and  fairly  runs  wild  with  exhilara- 
tion as  he  feels  the  impulses  of  new  life  and  vigor  thrilling  through 
his  nerves  and  bounding  in  his  veins,  and  finally  plunges  into  the  pool 
for  a  swim,  which  cools  and  tones  his  skin.  As  he  returns  again  to 
the  prison-house  of  conventional  clothing  in  which  civilized  human 
beings  are  compelled  to  live,  he  wishes  heartily  that  civilization  and 
nature  had  not  drifted  so  far  apart. 

"The  out-door  gymnasium  is  a  marvelously  potent  means  for  de- 
veloping the  restorative  and  healing  powers  of  the  body,  and  is  the 
natural  complement  of  the  various  thermic  procedures  of  the  hydri- 
atic  method.  No  sanitarium  can  be  considered  as  scientifically  com- 
plete without  a  well-equipped  out-door  gymnasium. 

"More  or  less  of  the  benefits  of  the  out-door  gymnasium  may  be 
obtained  by  out-of-door  exercises,  as  boating,  surf-bathing,  swim- 
ming, etc.  The  out-door  gymnasium  has  the  advantage,  however, 
that  it  may  be  employed  at  all  seasons  of  the  year,  that  the  exercises 
may  be  accurately  regulated  and  under  the  constant  supervision  of  a 
competent  director,  and  that  the  seclusion  of  the  gymnasium  affords 
opportunity  for  a  more  thorough  exposure  of  the  body  to  the  influ- 
ence of  light  and  air  than  ordinary  out-of-door  exercises. 

"For  feebler  patients,  carriage  riding  provides  a  partial  air  bath, 
which  may  be  advantageously  utilized  while  strength  for  a  more  vig- 
orous exercise  or  more  considerable  degree  of  exposure  is  being  ac- 
cumulated. Very  feeble  patients  may  be  allowed  to  lie  out  on  veran- 
das, or  in  sheltered  places  on  cots  or  reclining  chairs.  This  measure 
the  writer  has  employed  extensively  for  more  than  a  score  of  years, 
and  with  most  excellent  results.  The  patient  is  as  lightly  covered  as 
is  consistent  with  comfort ;  the  wraps  should  consist  of  white  woolen 
blankets  in  cold  weather,  and  white  fabrics  at  all  seasons,  so  that  as 
much  light  as  possible  may  penetrate  to  the  skin.  The  writer's  general 
instruction  to  his  patients  is  to  spend  as  much  time  as  possible  in  the 


Plate   17 — Incandescent  Electric  Li°ht   Bath. 


Plate  18 — Incandescent  Electric  Light  Bath.  Horizontal. 


ASSOCIATED  PROCEDURES.  67 

open  air.  Simply  lying  in  the  cool  fresh  air  promotes  appetite  and 
normal  metabolism,  and  greatly  adds  to  the  beneficial  effects  derived 
from  other  therapeutic  measures." 

It  is  the  author's  belief  that  a  combination  of  those  measures  which 
enable  an  exposure  of  the  body  to  the  action  of  sunlight,  the  air  itself, 
and  cold  bathing,  is  the  ideal  one  for  the  city  dwellant  who  seeks  a 
summer  vacation  or  rest.  This  is  especially  true  of  the  bookkeeper, 
clerk,  or  professional  man  who  is  confined  for  the  major  portion  of  the 
year  within  the  walls  of  an  artificially  heated  and  lighted  building. 
It  is  only  in  natural  surroundings  that  a  store  of  health  and  vitality 
can  be  laid  up  that  will  enable  individuals  to  go  for  a  long  time  along 
the  road  of  life's  struggles  without  the  necessity  of  combating  ill- 
health.  Experience  has  taught  me  that  it  is  wise  and  profitable  to  send 
those  living  at  or  near  the  sea-coast  to  the  mountains,  the  inlander  or 
mountaineer  to  the  sea-shore.  In  addition  all  should  be  enjoined  to 
drink  freely  of  water  while  undergoing  any  form  of  sun  or  air  treat- 
ment. 

Therapeutic  Application. 

The  therapeutic  application  of  sunlight  naturally  resolves  itself 
into  two  categories — to  maintain  and  acquire  health.  The  worn-out, 
fatigued  denizen  of  the  city  may  look  for  strength  and  recuperation 
from  a  life  under  the  sun's  rays;  the  anemic  and  chlorotic  girl,  the 
adult  with  malnutrition,  chronic  dyspeptics,  the  rheumatic,  gouty  and 
plethoric  individual,  the  diabetic,  the  neurasthenic,  will  all  find  a 
sun  bath  of  advantage  in  the  treatment  of  their  malady.  The 
different  organic  processes  of  the  body  are  stimulated,  oxidation  takes 
place  more  rapidly,  health  is  maintained.  Those  individuals  who  have 
a  dry,  sallow,  leathery  sort  of  skin,  who  are  suffering  from  the  poison- 
ing of  retained  secretions,  may  expect  from  the  utilization  of  the  out- 
door gymnasium,  country  life  with  swimming,  or  a  sojourn  at  the  sea- 
shore, the  maximum  amount  of  good,  for  these  measures  will  improve 
the  quantity  and  quality  of  the  blood,  will  eliminate  and  destroy  con- 
tained toxins  within  the  system,  and  promote  nervous  vitality.  Care, 
of  course,  should  be  exercised  in  habituating  one's  self  to  the  action 
of  the  sun's  rays,  and,  by  gradual  pigmentation  of  the  skin,  secure 
protection  from  its  dangers.  Those  who  are  so  situated  that  they 
cannot  leave  business  or  professional  life  will  be  benefited  by  riding, 
driving,  automobiling,  boating,  swimming,  bicycling,  golfing,  or  any 
other  sport  that  carries  them  into  the  sunlight  and  fresh  air.  Where 
persons  are  sensitive  to  the  action  of  light,  it  may  become  necessary  to 
train  the  nervous  system  to  stand  exposure.  It  is  best  to  wear  at  the 
start  a  thin  straw  hat,  substituting  for  this  a  light  cap,  and  later  on 
going  without  any  covering  upon  the  head  at  all.  Therapeutic  ex- 
posure to  sunlight   should  always  be   followed  by  the  application  of 


68  ACTICAL  HYDROTHERAPY. 

some  cooling  procedure,  any  number  of  which  will  be  described  later 
on  in  this  volume. 

In  conclusion,  it  may  be  said  that  sunlight  is  a  source  of  heat; 
that  in  its  action  upon  the  body  it  is  a  powerful  tonic;  that  it  increases 
the  hemoglobin  of  the  blood,  stimulates  and  tones  the  nervous  -ystem, 
favors  tissue  change,  and  is  destructive  in  its  action  upon  bacteria. 

The  Incandescent  Electric  Light  Bath. 

The  incandescent  electric  light  bath,  "artificial  sunshine,"  the  intro- 
duction of  which  into  therapeutics  we  owe  to  Kellogg,  is  one  of  the 
most  powerful  and  beneficial  of  those  treatments  placed  in  the  hands 
of  the  skilled  hydriatist.  There  is  probably  no  more  interesting  con- 
sideration than  the  transmutation  of  energy  found  in  the  electric  light 
bath.  Let  us  go  back  ages  upon  ages,  to  the  subcarboniferous  period, 
when  the  vegetation  was  mammoth,  and  the  ''reeds  and  rushes  grew 
tall  and  rank"'  under  the  sun's  rays  of  that  period ;  when  vegetation 
grew  and  developed  to  become  the  basis  of  the  different  coal  measures 
of  the  present  day.  With  the  Titanic  upheaval  and  compression,  with 
the  application  of  heat  from  unknown  regions,  this  mass  of  vegeta- 
tion was  compressed  and  prepared  for  the  utilization  of  man  after  his 
advent  upon  this  earth.  Dug  from  the  mines,  the  black  diamond  burns, 
causes  its  stored  sunshine  to  convert  the  water  into  steam;  the  steam, 
in  its  turn,  moves  the  machinery  by  which  the  dynamo  converts  the 
energy  of  the  coal  into  "artificial  sunshine,"  and  thus  we  may  literally 
say  that  we  are,  when  the  incandescent  light  is  turned  on.  basking  in 
the  sunlight  of  the  carboniferous  era;  and  this  analog}-  is  further 
carried  out  in  its  action  and  therapeutic  application,  for  it  is  the  near- 
est approach,  in  my  opinion,  to  sunshine  that  we  have  yet  discovered. 
This  form  of  procedure  acts  upon  the  tissues  in  the  same  manner  as 
sunlight  itself.  Instead  of  slowly  entering  the  tissues  by  means  of 
conduction,  and  imperfectly  penetrating  the  skin,  the  human  body 
permits  the  rays  of  electric  light  to  pass  readily  through  the  dermis, 
and  thus  generate  heat  in  the  depths  of  the  tissues,  and  this  it  does 
in  a  short  time  and  without  the  depressant  action  of  heat  by  conduc- 
tion. That  it  penetrates  the  tissues  readily  can  be  demonstrated  by 
placing  the  hand  over  an  ordinary  incandescent  bulb,  when  it  will  be 
noticed  that  the  soft  parts  are  illuminated.  The  electric  light  bath  has 
so  many  advantages  over  all  other  methods  of  heating  that  the  author 
feels  too  much  attention  cannot  be  paid  to  this  agent  in  the  treatment 
of  disease.  Incandescent  electric  light  is  generated  by  the  dynamo, 
and.  passing  along  a  wire  properly  insulated,  enters  the  bulb,  where  it 
meets  with  resistance.  The  bulb,  a  discovery  of  Edison's,  is  a  vacuum 
provided  with  an  entrance  and  exit  wire.  Within  the  vacuum  a  prop- 
erly constructed  terminal  offers  resistance  to  the  passage  of  the  cur- 
rent, the  resistance  converting  the  current  into  light  and  heat.     The 


ASSOCIATED  PROCEDURES. 

electric  light  bath  does  not  depend  for  all  its  action  up<  n  the  heat  gen- 
erated,  but  mostly  upon  the  light  itself,  which  is  radiated  from  the  dif- 
ferent bulbs,  striking  the  cutaneous  surface.  There  are  two  forms  of 
electric  light  hath  of  which  we  shall  speak,  viz.,  the  incandescent  and 
the  arc. 

Physiological  Action  of  the  Incandescent  Electric  Light  Bath. 

This  bath  is  most  frequently  used  for  the  accumulation  of  heat 
upon  the  surface  of  the  body,  and  to  induce  perspiration.  It  is  much 
superior  to  any  other  method,  is  easily  controlled,  and  the  dosage 
satisfactorily  regulated  as  to  duration  and  intensity.  It  has  an  advan- 
tage over  all  other  methods,  in  that  the  instant  the  switch,  controlling 
the  circuit  is  closed  every  lamp  is  brought  into  play,  at  once  throwing 
its  whole  force  upon  the  body.  It  acts  quickly  as  a  heating  procedure. 
bringing  about  an  elevation  of  body  temperature,  followed  by  per- 
spiration. 

Action  Upon  the  Skin. — Careful  clinical  studies  made  by  the  author 
during  the  past  twelve  years  warrant  him  in  the  assertion  that  this 
electric  light  bath  stands  at  the  head  of  all  methods  as  the  most  satis- 
factory, safe  and  efficient  way  by  which  perspiration  can  he  induced. 
By  means  of  its  penetration,  electric  light  stimulates  directly  the  blood- 
vessels of  the  perspiratory  glands  and  at  the  same  time  raises  body 
temperature  by  its  action  within  the  tissues.  It  is  not  altogether  the 
action  of  heat  itself  upon  the  surface  of  the  body,  but  radiant  energy. 

Bouchard  has  stated  that  if  we  elevate  the  temperature  of  the 
blood  seven-tenths  of  a  degree  Fahrenheit,  there  will  be  produced  sen- 
sible perspiration.  This  is  accomplished  in  a  much  shorter  time  than 
by  any  other  means  of  heat  application,  for  the  light,  penetrating  the 
skin  as  light,  and  encountering  the  resistance  of  the  tissues  beneath. 
has  its  energy  transformed  into  heat,  and  it  is  for  this  reason  that  we 
are  able  to  produce  effects  with  the  electric  light  bath  in  one-third  to 
one-half  the  time  that  is  ordinarily  necessary  wdien  we  use  other 
methods.  Incidentally,  there  is  an  economic  side  in  the  saving  of 
time,  which  is  frequently  valuable  when  giving  this  kind  of  treatment. 
Again,  I  wish  to  call  attention  to  the  fact  that  the  radiant  enrgy  of 
the  bath,  when  used  as  a  heating  procedure,  is  a  powerful  tonic  and  not 
a  depressant. 

When  the  body  is  placed  within  the  apparatus,  the  skin  commences 
to  redden,  accompanied  by  a  dilatation  of  the  superficial  trunk  blood- 
vessels and  small  capillaries.  Shortly  after  this,  perspiration  takes 
place. 

Action  Upon  Metabolism. — Radiant  energy  entering  the  body  as 
it  does,  acts  as  a  powerful  vitalizer  and  stimulant  to  cellular  activity. 
That  it  produces  changes  in  the  system  analogous  to  that  of  sunshine 
has  long  been  recognized,  and  it  is  interesting  at  this  point  to  note  the 


70  PRACTICAL  HYDROTHERAPY. 

observation  of  Siemens,  who  found  that  "when  plants  and  vegetables 
were  exposed  to  the  electric  light  at  nighttime,  it  was  comparable  to 
the  sunlight  in  producing  protoplasmic  activity,"  and  that  "the  electric 
light  acts  as  a  tonic  to  plants,  so  that  they  are  able  to  endure  adverse 
conditions  which  would  otherwise  cause  them  to  collapse ;  that  the 
electric  light  is  a  true  vital  stimulus,  since  the  effect  of  its  use  at  night 
upon  plants  is  essentially  the  same  as  that  of  the  longer  day  of  the 
arctics  upon  plants  growing  in  that  region."  The  electric  light  bath 
stimulates  metabolism,  as  has  been  shown  by  Kellogg  in  his  experi- 
ments, proving  it  to  be  a  reconstructor  of  tissue  and  an  eliminator  of 
toxins.  Elimination  of  carbon  dioxide  was  markedly  increased,  al- 
though the  temperature  of  the  bath  was  kept  constantly  below  that 
of  the  body,  viz.,  97°  F.  The  urinary  secretion  showed  a  diminished 
amount  of  urea  and  total  solids  during  the  twenty-four  hours,  which 
was  evidently  the  result  of  increased  elimination  by  the  skin,  thus 
stamping  this  bath  as  a  powerful  vicariant,  a  fact  that  is  borne  out  by 
daily  clinical  experience  in  the  treatment  of  rheumatism,  Bright's 
and  diseases  of  metabolism.  The  writer's  observations  and  experi- 
ments have  shown  him  that  where  the  electric  light  bath  is  used  in 
connection  with  other  hydriatic  procedures,  there  is  a  marked  increase 
in  the  excretion  of  urea  and  solids  in  the  urine  and  diminution  of 
uric  acid  and  the  uro-toxic  group.  That  nutrition  is  stimulated  by 
this  bath  I  have  experimentally  determined  by  a  study  of  the  gains  in 
weight.  In  some  cases  this  is  marked,  and  occurs  in  spite  of  the 
fact  that  the  patient  remains  upon  a  toxic  diet — that  is  to  say,  a  diet  in 
which  meat  forms  a  fair  proportion  of  the  ingesta.  The  above  changes 
•.are  enhanced  by  the  action  of  the  rays  upon  the  blood  itself. 
The  electric  light  bath  produces  an  increase  in  hemoglobin  as  well 
as  red  corpuscular  richness. 

Upon  the  nervous  system  the  electric  light  bath  is  a  tonic,  stimu- 
lant and  vitalizing  process,  from  which  we  may  expect  excellent  re- 
sults in  all  nervous  affections,  especially  when  accompanied  by  tox- 
emia. These  individuals  are  prone  to  feel  the  devitalizing  effects 
of  heat,  more  or  less  depressing  in  character,  and  for  this  reason  the 
electric  light  bath,  with  its  tonic  influence,  is  especially  adapted  as 
a  heating  procedure.  I  have  observed  that  nervous  patients  more 
quickly  and  satisfactorily  react  to  cold  water  treatment  when  the 
application  is  preceded  by  the  use  of  this  bath. 

The  action  of  the  local  electric  light  bath  upon  the  tissues  sub- 
jected to  its  influence,  viz.,  joints,  inter- joint  structures,  abdomen, 
chest,  spine,  etc.,  is  the  general  therapeutic  influence  of  the  incan- 
descent bath  above  enumerated,  except  that  its  action  is  localized 
within  the  tissues  subjected  to  its  rays.  Even  where  this  is  limited 
to  a  small  area,  such  as  a  joint,  there  is,  of  necessity,  a  general  in- 
fluence to  be  derived  from  its  application,  and  which  may  be  summed 


■ 


Plate  20 — Incandescent   Electric   Light   Bath.   Closed    (Mott). 


Plate  21 — Incandescent  Electric  Light  Bath,  Open   i  Mott  I. 


Plate  22 — Local  Incandescent  Electric  Light  Baths   (Kellogg). 


ASSOCIATED  PROCEDURES.  71 

up  in  the  statement  that  its  primary  and  local  application  produces 
in  the  locality  to  which  it  is  applied  the  same  action  as  a  general 
application,   with   mild   secondary  systemic  effects. 

The  Arc  Light  Bath. 

In  the  arc  light  bath  we  have  to  deal  with  an  active  energy  that 
is  considerable.  The  heat  from  the  arc  is  intense,  the  active  horse- 
power energy  of  which  is  said  to  be  greater  than  that  of  the  effective 
rays  of  the  sun  at  the  earth's  surface — that  is  to  say,  the  surface  of 
the  sun  radiates  10,000  horse  power  per  square  foot  of  its  surface, 
but  the  earth  receives  only  one-third  horse  power  per  square  foot, 
of  which  about  one-third  is  absorbed  into  the  atmosphere.  An  arc 
having  a  crater  of  one-twelfth  of  an  inch  is  estimated  to  radiate 
about  12,000  horse  power  energy,  which  is  in  excess  of  the  sun's 
power.  The  brightest  part  of  an  arc  is  a  small  area  within  the  crater 
of  the  positive  carbon,  the  temperature  of  which  is  approximately 
from  6,200°  to  6,300°  F.  It  is  from  that  spot  that  the  greater  part 
of  the  energy  is  derived,  and  which  compares  with  the  sun  in  bright- 
ness. In  the  arc  light  we  have  to  deal  more  particularly  with  the 
actinic  or  chemical  rays  of  light,  and  it  is  from  their  influence  that 
we  may  expect  benefit  to  the  diseased  human  body.  While  the  arc 
light  emits  powerful  and  stimulating  rays,  still  it  does  not  compare 
for  general  use  with  the  incandescent  bath. 

In  its  physiological  action  upon  the  surface  of  the  body  the  skin 
is  stimulated — even  irritated — by  its  rays,  resulting  in  a  dilatation  of 
the  capillaries  and  larger  blood-vessels,  accompanied  by  a  rise  in 
temperature  and  active  fluxion  of  blood  to  the  surface.  Perspiration 
is  induced,  and,  where  the  heat  of  the  arc  light  is  retained,  we  have 
superadded  all  the  influences  that  arise  from  heat  of  any  kind,  with 
the  added  advantage  of  its  vitalizing  action.  I  consider  the  arc  light 
better  suited  for  localized  treatments,  especially  superficial  in  char- 
acter 

Actinic  rays  emanataing  from  the  arc  light  are  germicidal  in  their 
action,  and  are  destructive  to  bacteria  upon  the  surface  of  the  skin, 
as  in  lupus,  though  they  do  not  penetrate  beneath  the  surface.  The 
aim  in  the  arc  light  bath  is  not  so  much  the  production  of  heat  effects 
as  the  more  purely  actinic  surface  action.  The  arc  light  bath  is,  as 
a  rule,  little  used  by  hydriatists,  but  belongs  more  particularly  to 
another   field   or   specialty. 

Technique. — Many  electric  light  baths  are  now  constructed  and 
upon  the  market,  and  from  which  the  intending  purchaser  can  select, 
but  certain  rules  should  be  borne  in  mind.  It  is  essential  that  the 
wood  entering  into  its  composition  should  be  preferably  of  oak, 
well  seasoned,  and,  in  addition,  kiln  dried.  The  wires  entering  the 
cabinet    and    connected    with    the    different    incandescent    lights    mu-.t 


72  PRACTICAL  HYDROTHERAPY. 

be  large,  •well  insulated,  and  where  a  connection  is  made  the  connection 
should  be  soldered  and  the  joint  well  taped.  I  personally  prefer  the 
Edison  or  screw  base  for  the  globe  itself,  as  I  believe  in  this  way  the 
light  is  more  secure  and  a  better  contact  made.  In  cities  the  alter- 
nating current  is  generally  used,  with  a  voltage  from  52  to  110,  the 
latter,  for  a  number  of  reasons,  being  preferable,  as  it  gives  a  steadier 
light,   somewhat  more   intense   in   its   action. 

In  1895  the  author  constructed  his  first  electric  light  bath,  and 
has  deviated  little  from  the  model  he  then  adopted.  1  have  always 
believed  in  a  superabundance  of  lights ;  in  fact,  twice  as  many  as  are 
really  necessary,  so  that  almost  any  degree  of  heat  or  light  effects 
may  be  obtained.  The  cabinet  I  now  use  can  be  constructed  by  any 
really  good  mechanic.  It  is  4x4  feet,  with  a  floor  on  the  inside  at 
such  a  height  as  to  make  it  comfortable  for  one  to  sit  upon  a  re- 
volving stool  with  the  head  outside.  A  door  of  sufficient  size  opens 
to  admit  the  entrance  of  the  patient.  The  interior  is  lined  with  asbes- 
tos and  is  supplied  with  138  16-candle  power  lights  arranged  in 
vertical  rows  equidistant  from  one  another,  with  the  exception  that 
there  are  two  double  rows  placed  opposite  the  spine  of  the  patient. 
The  lights  are  mounted  upon  porcelain  bases,  and  between  them  are 
placed  French  plate  glass  mirrors  so  that  there  may  be  multiplication 
by  reflection.  The  wiring  is  carried  through  the  cabinet  in  porcelain 
conduits  to  a  switch-board,  of  which  I  shall  speak  later.  A  false 
outer  shell  covers  the  wires  and  conduits,  so  as  to  give  the  cabinet 
a  pleasing  appearance.  The  switch-board  has  snap  or  double  knife- 
blade  switches,  one  for  every  row  of  lights.  The  advantage  of  this 
is  at  once  apparent,  as  the  physician  is  enabled  to  regulate  the  number 
of  lights  and  grade  the  intensity  of  the  application.  It  is  advantageous 
to  have  a  very  large  double  knife-blade  switch  on  the  main  wires 
of  the  current,  but  the  novice  should  remember  never  to  throw  in 
this  large  switch  when  the  smaller  switches  are  all  turned  on,  as  he 
may  "blow  out"  the  fuse  now  required  upon  all  such  currents. 

In  practice  the  patient  enters  the  bath  and  takes  his  seat  upon 
the  revolving  piano  stool,  which  can  be  raised  or  lowered  to  suit 
the  body  length.  His  spine  is  uniformly  exposed  to  that  portion  of 
the  cabinet  containing  the  double  row  of  lights.  The  board  is 
dropped  into  place  around  the  neck  and  the  door  closed ;  a  large 
towel  is  then  put  loosely  around  the  neck  to  prevent  the  escape  of 
heat.  This  is  a  small  matter,  but  it  is  an  exceedingly  disagreeable 
one  to  a  patient  to  have  the  hot  air  of  the  cabinet  stream  in  front 
of  his  face,  and  I  have  known  cases  to  be  made  faint  by  just  such  a 
neglect  of  detail.  In  the  case  of  men  a  cold  cloth  or  ice-cap  is  placed 
upon  the  head ;  women  may  wear  an  oil-silk  or  rubber  cap,  over 
which  is  placed  the  ice-cap  or  cold  cloth,  or,  what  is  better,  have 
a  cold  towel  wrapped  around  the  upper  neck  or  throat.     Recently  I 


pLATE  23— Light  and  Arc  Cabinet  Combined,  Open  I  Monell). 


Plate  24 Light  and  Arc  Cabinet  Combined,  Closed  (Monell). 


ASSOCIATED  PROCEDURES.  73 

have  used  with  much  satisfaction  a  rubber  helmet  which  has  a  suffi- 
ciently large  mouth  U>  permit  small  pieces  of  ice  to  be  introduced. 
This  helmet  keeps  the  head  cool,  docs  not  wet  the  hair,  and  is  espe- 
cially appreciated  by  ladies.  As  a  result  I  have  entirely  dispensed 
with  the  turban,  pad  or  cold  collar  in  my  practice. 

This  is  done  for  the  purpose  of  preventing  the  fluxion  of  blood  to 
the  head,  which  would  be  followed  by  faintness5  vertigo,  palpitation, 
etc.  The  duration  of  the  bath  will  depend  upon  the  individual  case, 
but  ranges  somewhere  between  three  and  twenty  minutes.  It  is  a 
common  fact  that  cases  at  the  start  require  very  much  longer  ex- 
posure to  the  action  of  the  bath,  and  that  as  improvement  takes  place 
there  is  a  more  rapid  and  prompt  response  of  the  body  to  the  influence 
of  the  light,  and  therefore  the  duration  becomes  lessened.  The 
incandescent  hath  may  be  used  in  two  ways.  Where  the  patient  is 
only  permitted  to  remain  in  the  cabinet  until  the  skin  is  flooded  with 
blood,  but  perspiration  has  not  taken  place,  a  powerful  tonic  and  stim- 
ulating procedure  takes  place  without  many  of  the  eliminative  and 
other  actions  heretofore  described.  "Where  the  patient  remains  until 
free  perspiration  takes  place  the  physiological  action  above  described 
is  the  result. 

In  the  author's  hands  the  incandescent  electric  light  bath  is  merely 
an  associative  procedure,  a  measure  by  means  of  which  he  stimulates, 
vitalizes  and  prepares  his  patient  for  hydriatic  methods,  of  which  the 
reader  will  find  any  number  described  in  later  chapters  of  this  work. 

Therapeutic  Application. — As  indicated  above,  the  author  has 
found  the  incandescent  electric  light  bath  to  be  the  most  successful  of 
all  known  methods  as  a  preliminary  to  further  hydriatic  measures 
and  for  the  application  of  heat  to  the  general  body  surface.  In 
localized  procedures  I  have  had  better  success  with  superheated  dry 
hot  air.  The  adaptability  of  the  light  bath  to  every  case  is  easily 
accomplished  by  means  of  the  switch-board ;  by  changing  the  number 
of  lamps  the  intensity  of  the  bath  is  regulated.  This  bath  is  instantly, 
absolutely  and  positively  under  the  control  of  the  operator.  In  an 
electric  light  bath  of  short  duration,  followed  by  any  of  the  cold  per- 
cutient  measures  hereafter  described,  we  have  a  combination  of 
effects  far  reaching  in  their  action  and  of  marvelous  reconstructive 
capacity.  Wmere  the  bath  is  continued  until  free  perspiration  takes 
place  the  patient  should  remain  from  five  to  fifteen  minutes,  but  in 
any  event  must  be  followed  by  some  cooling  application.  I  have 
found  the  combination  of  the  electric  light  bath  with  hydriatics  one 
of  the  most  powerful  known  measures  for  overcoming  anemia  and 
chlorotic  conditions,  especially  in  young  women.  As  an  enhancer 
of  appetite,  increasing  digestive  capacity  and  overcoming  intestinal 
torpor,  it  is  the  remedy  par  excellence.  Those  suffering  from  gout, 
lithemia,    rheumatism    (acute    and   chronic),    the   uric    acid    diathesis, 


74  PRACTICAL  HYDROTHERAPY. 

myositis  and  myalgia  dependent  upon  these  conditions,  will  find  relief 
in  the  painstaking  and  persistent  application  of  these  measures.  In 
neurasthenia,  hysteria,  insomnia,  neuralgia,  neuritis,  migraine,  chorea, 
and  all  functional  nervous  troubles,  it  is  invaluable.  I  consider  the 
electric  light  bath  and  hydriatic  procedures  for  chronic  malaria  and 
syphilis,  as  a  supplement  to  the  use  of  quinine,  mercury  and  the 
iodides,  unequaled  by  any  other  known  therapeutic  resource.  The 
local  electric  light  bath  is  useful  in  the  treatment  of  painful  condi- 
tions and  local  disorders.  It  is  of  special  use  in  spinal  neuralgias, 
spinal  irritation,  lumbago,  localized  pains  of  all  kinds,  etc.,  but  after 
its  application  either  localized  or  general  applications  of  cold  should 
be  made. 

For  the  application  of  the  arc  light  in  therapeutics  the  reader  is 
referred  to  the  cut  of  the  combined  incandescent  and  arc  bath,  either 
of  which  can  be  used  singly.  As  heretofore  indicated,  the  arc  light 
bath  finds  its  greatest  usefulness  in  skin  affections,  neurasthenia  and 
general   debility  and   in  painful  nervous   states. 

Hot  Air  Cabinet;     Turkish  Bath;     Vapor  Cabinet;     Russian  Bath; 
and  Superheated  Dry  Hot  Air. 

I  have  grouped  these  procedures  under  one  general  heading,  as 
the  physiological  action  of  each  is  practically  the  same,  the  minor 
differences  being  of  such  a  nature  as  not  to  invalidate  the  added  value 
of  considering  them  collectively.  They  differ  essentially  and  rad- 
ically from  the  action  of  sunlight  and  radiant  energy,  in  that  the 
applications  produce  their  results  by  directly  communicating  heat  to 
the  surface  and  from  there  entering  the  tissues  by  conduction. 

A  human  being  can  tolerate  a  water  bath  at  a  temperature  of 
113°  F.  (45°  C.)  for  eight  minutes'  duration  with  danger  to  life, 
while  a  general  hot-air  bath  at  a  temperature  of  260°  F.  (127°  C.) 
for  eight  minutes  is  well  borne,  and  temperatures  far  exceeding  this — 
350°  and  400°  F. — can  be  applied  to  the  general  surface  or  localized, 
provided  certain  precautions  are  taken.  Of  all  these  baths  the 
Turkish  is  the  oldest.  The  physiological  action  of  the  Turkish  bath 
and  the  hot-air  cabinet  is  practically  the  same,  with  the  added  advan- 
tage in  favor  of  the  cabinet,  though,  as  I  will  show  later  on,  the 
cabinet  in  the  home  is  very  much  abused.  The  user  of  the  cabinet 
inhales  fresh  air  and  the  pulmonary  mucous  membrane  is  not  sub- 
jected to  the  direct  action  of  the  hot  air  itself.  Perspiration  is  more 
rapid  in  the  hot-air  bath  and  in  the  superheated  dry  hot  air  and  least 
so  in  the  presence  of  steam ;  in  fact,  the  presence  of  water  of  any  kind 
interferes  with  the  secretion  of  perspiration.  The  North  American 
Indians  used  to  improvise  a  Russian  bath  by  pouring  water  upon 
heated   stones,  and  in  Finland  the  same  process  is   followed  to-day. 


H 


3 

o 


ASSOCIATED  PROCEDURES.  75 

The  Eskimo  uses  hot  air,  building  a  fire  in  his  hut,  raising  the  air  of 
the  chamber  to  such  a  temperature  as  to  produce  free  and  active  per- 
spiration. The  Finns  and  Eskimos  suddenly  leave  their  apartments 
and  plunge  into  the  snow,  a  somewhat  rigorous  procedure.  All  these 
baths  must  be  followed  by  some  temperature-reducing  method,  any 
number  of  which  will  be  found  in  a  subsequent  chapter. 

Physiological  Action  of  Heat  by  Conduction. 

The  primary  physiological  influence  of  hot  air  or  steam  upon  the 
body  is  the  result  of  thermic  irritation  conducted  to  the  structures  and 
tissues  beneath  the  integument.  When  a  person  enters  the  hot-air 
room  or  steps  into  the  cabinet,  after  a  short  or  longer  period  of  time, 
usually  from  three  to  ten  minutes,  the  surface  of  the  body  begins  to 
become  warm.  Gradually  the  layers  of  the  skin  absorb  the  heat  until 
it  reaches  the  lower  structures  and  acts  upon  the  blood-vessels  them- 
selves. The  skin  then  fills  with  blood,  the  perspiratory  glands  begin 
to  discharge  their  secretion  upon  the  surface,  at  the  start  in  the  nature 
of  a  dampness,  later  along  in  beads,  as  the  fluids  of  the  body  are  more 
freely  directed  toward  the  surface.  Thirst  is  now,  as  a  rule,  ex- 
perienced, and  the  patient  should  be  made  to  drink  freely  of  plain  or 
carbonated  water.  Heat  thus  applied  is  for  a  short  time  a  vital 
stimulant,  acting  upon  all  the  structures,  tissues  and  glands  with 
which  it  is  brought  in  contact,  but  only  of  a  temporary  nature,  and 
is  followed  by  its  natural  or  secondary  effect,  viz.,  depression.  This 
depressant  or  atonic  effect  is  disagreeable,  and  must  be  carefully 
guarded  against.  In  the  Turkish  bath  the  inhalation  of  the  dry  hot 
air  not  only  excites  the  skin,  but  stimulates  the  enormous  area  of  the 
pulmonary  circulation,  and  to  a  certain  extent  favors  the  elimination 
of  toxins  by  this  membrane.  Its  action  upon  the  skin  remains  for 
some  hours  after  the  bath. 

The  value  of  sweating  as  an  eliminative  measure  is  perhaps  not 
so  great  as  it  has  been  popularly  believed  to  be,  the  percentage  of 
urea  and  other  toxins  contained  in  the  sweat,  especially  when  profuse 
perspiration  is  induced,  is  small — indeed,  very  small — when  com- 
pared with  the  percentage  of  these  tissue  poisons  as  ordinarily  found 
in  the  urine.  However,  under  some  circumstances,  they  are  carried 
off  through  the  skin,  as  is  evidenced  by  the  peculiar  urinous  odor 
noticeable  when  profuse  perspiration  is  induced  in  a  patient  suffering 
from  renal  insufficiency. 

The  sweating-bath  (followed  by  a  cold  application),  though  by 
no  means  a  perfect  substitute,  does,  nevertheless,  to  a  very  consider- 
able degree  relieve  the  system  of  the  excrementitious  wastes  which 
accumulate  within  the  body  when  a  sufficient  amount  of  exercise  is 
not  habitually  taken.  This  is  accomplished  by  increasing  oxidation 
and    renewing   the    body    by    stimulating   tissue    changes.  '     Sweating 


76  PRACTICAL  HYDROTHERAPY. 

softens  the  sebaceous  matter  which  often  accumulates  in  the  ducts  of 
the  skin  and  loosens  the  dry  epithelium  that  obstructs  the  outlets  of 
the  perspiratory  ducts. 

It  is  practically  impossible  to  effect  a  permanent  cure  in  a  large 
number  of  chronic  disorders  without  first  restoring  the  skin  to  a 
normal  state.  Diseased  conditions  are  common  among  civilized  races 
because  of  the  influence  of  clothing  and  the  neglect  of  a  daily  bath. 
Sweating-baths  are  of  the  highest  value  as  a  means  of  ridding  the 
skin  of  its  accumulated  impurities,  opening  up  the  obstructed  lymph- 
channels  and  spaces,  encouraging  the  circulation  of  nutritive  fluids, 
stimulating  gland  structures,  unloading  obstructed  sebaceous  follicles 
of  their  hardened  contents,  arousing  to  activity  the  nerve  ganglia  and 
secreting  cells  of  internal  organs  through  reflex  movements  set  up 
by  the  cutaneous  sensory  impressions  made,  and  relieving  by  skin 
activity  visceral  congestion  and  other  functional  disturbances. 

Respiration  is  increased  in  frequency  in  from  three  to  five  min- 
utes, and  becomes  more  superficial  and  supracostal  in  character.  For 
a  while  there  is  more  or  less  oppression  until  relief  is  afforded  by  the 
breaking  out  of  perspiration  and  the  elimination  of  moisture  from  the 
2,000  square  feet  of  pulmonary  mucous  membrane.  With  the  watery 
vapor  escape  CO.,  and  toxic  substances,  volatile  in  their  nature,  to 
which  Charrin  has  called  our  attention.  The  probable  explanation  of 
the  physiological  increase  of  respiration  during  the  application  of 
these  measures  to  the  surface  is  to  be  found  in  a  combination  of 
factors — irritation  of  the  peripheral  nerve  terminations,  superheated 
blood  carried  to  the  vagus  respiratory  center  in  the  medulla,  an 
increase  of  carbon  dioxide  demanding  respiratory  action  to  permit  of 
oxygen  absorption. 

Heat  profoundly  affects  the  circulation.  After  the  patient  enters 
the  bath  the  pulse-rate  begins  to  increase,  and  in  from  five  to  ten 
minutes  it  may  rise  from  twenty  to  fifty  beats.  A  continuance  of  the 
application  causes  an  active  congestion  of  the  skin,  which,  with  the 
induction  of  perspiration,  becomes  soft  and  lax.  The  arterial  trunk 
and  capillaries  become  distended  with  blood,  especially  the  latter, 
for,  possessing  only  a  thin  cellular  membrane,  they  are  capable  of 
enormous  dilatation  and  expansion,  frequently  several  times  their 
normal  size.  With  the  increased  activity  of  the  circulation  in  the 
skin,  with  the  acceleration  of  the  pulse,  blood  pressure  is  lowered,  a 
fact  discernible  by  the  finger  and  sphygmomanometer.  Owing  to 
the  lessened  resistance  of  the  peripheral  arterial  system,  the  blood 
stream  is  propelled  with  less  labor  to  the  surface  and  anemia  of  the 
internal  viscera  takes  place,  especially  of  the  brain.  A  sensation  of 
faintness,  vertigo  and  tinnitus  is  far  more  common  in  Turkish  and 
Russian  than  in  the  cabinet  bath,  because  in  the  latter  the  head  is 
kept  cool  and   fresh  air  respired.     With   free  perspiration  the  pulse- 


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.  ISSOCL  I  TED  PROCEDURES.  77 

rate  diminishes  some,  relaxation  takes  place  and  the  oppression  and 
di.--eop.ii',  >rt  disappear. 

rhe  first  effect  of  these  applications  upon  the  nervous  system 
is  that  of  a  stimulant,  exciting  the  nerve  centers  through  reflex 
action  arising  from  impressions  made  by  the  thermic  irritation 
upon  the  skin.  This  is  of  short  duration  and  is  followed  by  a  pecu- 
liarly agreeable  sensation  of  ease  and  languor.  Continued  for  a 
longer  period  of  time,  exhaustive  symptoms  begin  to  appear,  notably 
lassitude,  mental  as  well  as  muscular,  the  ultimate  end  of  which  is 
intense  depression. 

The  multitude  of  thermic  impressions  that  arise  from  heating  pro- 
cedures act  reflexly  upon  the  central  nervous  system,  assisted  by  the 
direct  action  of  the  heated  blood  upon  the  nerve  centers  themselves. 

The  anemia  resulting  from  the  increased  circulation  in  the  skin 
is  an  added  feature.  Its  action  upon  voluntary  and  involuntary 
muscular  fiber  is  the  same.  A  short  general  application  of  heat  is 
stimulant  in  practically  the  same  manner  as  a  short  application  of 
cold,  while  its  prolonged  use  has  the  reverse  effect,  lowering  tone, 
energy  and  relaxing  the  fibers.  This  fact  is  utilized  clinically  by  the 
medical  fraternity,  and  laity  as  well,  in  the  treatment  of  muscular 
cramps,  especially  those  of  the  intestines,  and  by  the  surgeon  in  over- 
coming strangulated  hernia  and  retention  of  urine. 

The  lassitude  that  accompanies  a  general  application  of  heat  is  to 
be  explained  by  its  depressing  nerve  effects  and  to  the  relaxation  of 
muscular  tissue  itself. 

L  pon  the  blood  heat  diminishes  the  number  of  red  cells  and  in- 
creases the  leucocytes,  and  this  is  true  whether  the  application  be 
general  or  local,  though  local  leucocytosis  is  much  more  marked  after 
localized  procedures  than  general  applications.  The  alkalinity  of  the 
blood  is  lessened,  diminishing  its  vital  resistance  and  increasing  its 
toxicity,  with  the  production  of  active  perspiration,  and,  provided  water 
is  not  drunk,  the  general  volume  of  the  blood  is  lessened,  due  to 
actual  water  loss. 

The  influence  of  heat  upon  the  digestive  apparatus  is  a  secondary 
one,  for  where  it  is  not  followed  by  the  proper  after-treatment  there 
is  a  relaxation  of  the  musculature  of  the  entire  tract,  with  a  retention 
of  gases,  indigestion  and  fermentation,  the  latter  giving  rise  to  putre- 
factive processes,  from  which  auto-intoxication  takes  place.  The  liver 
is  little  affected,  although  there  is  a  tendency  to  diminish  and  thicken 
the  biliary  secretion. 

The  action  of  heat  upon  metabolism  is  a  frequent  clinical  observa- 
tion. An  elevation  of  temperature  and  increased  circulatory  activity 
favor  oxidative  processes  and  carbon  dioxide  formation.  By  the 
action  of  prolonged  heat  some  fat  combustion  takes  place,  and  in  the 
reduction  of  obese  persons  this  measure,  together  with  the  restriction 


78  PRACTICAL  HYDROTHERAPY. 

of  fluids,  is  frequently  employed.  The  various  end-products  circulating 
in  the  blood  are  oxidized  and  put  in  more  favorable  condition  for  the 
action  of  the  eliminative  organs. 

Experiments  show  that  the  elevation  of  temperature  induced  by 
general  hot  applications  aids  the  body  in  the  formation  of  alexins  and 
antitoxins.  Animals  suffering  from  infectious  diseases  live  longer 
when  subjected  to  the  influence  of  moderate  heat.  The  recognition 
of  this  fact  has  led  to  the  revival  of  the  dictum  of  Hippocrates,  that 
the  elevation  of  temperature  that  occurs  in  connection  with  most  acute 
infectious  diseases  is,  within  limits,  remedial  in  purpose  and  effect. 
By  parallel  reasoning  we  are  led  to  the  conclusion  that  a  slight  degree 
of  pyrexia  artificially  induced  by  a  general  hot  application  may  be 
benficial  in  aiding  resistance  to  infection,  especially  when  followed  by 
a  short  cold  bath. 

Elimination  is  enhanced.  By  oxidative  processes  toxic  groups  are 
converted  into  urea,  and  this  end-product  is  eliminated  in  larger  quan- 
tities for  some  days,  even  after  the  application  of  one  bath.  Uric  acid 
itself  is  eliminated,  due  to  an  absorption  into  the  circulating  medium  of 
that  which  is  stored  in  the  tissues,  its  greatest  elimination  being  shortly 
after  the  bath ;  the  chlorides,  sulphuric  and  phosphoric  acids  and  ex- 
tractives are  favorably  influenced.  The  quantity  of  urinary  water 
lessens  somewhat  in  proportion  to  the  quantity  of  perspiration  induced. 

Local  superheated  dry  hot  air  produces  primarily  an  agreeable 
sensation  of  warmth  and  relaxation.  This  is  followed,  in  a  short  time, 
by  a  marked  increase  in  the  quantity  of  blood  circulating  in  the  vascular 
stems  and  capillaries  of  the  part  subjected  to  the  heat.  Relaxation, 
copious  perspiration  and  elevation  of  the  temperature  of  the  blood  take 
place.  Moderate  general  perspiration  ensues.  The  active  perspiration 
of  the  part  eliminates  a  great  many  toxic  materials,  both  organic  and 
inorganic,  and  this  is  of  value  in  the  treatment  of  localized  infections. 
Upon  the  nervous  system  it  acts  reflexly,  checking  pain  in  a  marvelous 
way.  In  the  writer's  somewhat  extended  experience  of  eighteen  years 
nothing  has  proved  more  gratifying  to  him  than  the  influence  of  super- 
heated dry  hot  air  locally  for  the  relief  of  pain  and  paresthetic  sensations 
which  so  frequently  accompany  painful  states.  Reflexly,  the  pulse-rate 
and  respiration  are  slightly  accelerated  by  localized  applications  of  dry 
hot  air.  These  applications  produce  profound  trophic  influences  upon 
the  part,  especially  observable  in  the  improved  nutrition  that  takes 
place  in  gouty  extremities  and  around  the  joints  of  arthritis  deformans. 
That  it  enhances  function,  increases  tissue  resistance  and  stimulates 
reconstruction  is  a  constant  observation.  Upon  the  lymphatic  system 
dry  hot  air  increases  the  flow  along  its  channels,  whipping  up  glandular 
action,  and  thereby  aiding  in  the  removal  of  waste  products.  The 
elevation  of  temperature  to  which  the  part  is  subjected  favors  oxida- 
tion and  the  destruction  of  effete  materials.     It  may  be  stated  that, 


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ASSOCIATED  PROCEDURES.  79 

barring  the  intense  local  effects,  the  general  influence  is  that  heretofore 
enumerated  in  the  preceding  pages  of  this  chapter.  I  have,  so  far, 
failed  to  notice  in  the  literature  of  this  subject  the  application  of  local- 
ized cooling  methods  after  the  use  of  this  agent.  In  the  limb,  or  part 
subjected  to  the  heat,  are  greatly  relaxed  blood-vessels  and  tissues,  and 
it  is  necessary,  in  order  to  produce  reaction  and  maintain  the  blood  in 
the  part,  that  the  treatment  should  be  followed  by  a  brief  application 
of  some  tonic  and  temperature-abstracting  procedure;  otherwise  the 
part  will  become  gradually  chilled  by  evaporation  of  perspiration  and 
the  condition  may  be  aggravated  rather  than  helped.  The  writer  has 
found  it  of  considerable  value  to  not  only  use  a  localized  application 
of  cold,  but  a  general  systemic  one. 

Apparatus  and  Technique. 

The  apparatus  and  the  methods  here  described  of  necessity  limit 
their  use  to  sanatoria,  institutions  and  hospitals  provided  with  a 
thorough  and  complete  outfit,  which,  the  writer  is  sorry  to  confess, 
is  a  rarity  when  we  consider  the  number  of  private,  public,  special 
and  general  hospitals  and  sanatoria.  In  considering  technique  it  must 
be  borne  in  mind  that  the  greatest  care  should  be  exercised  to  avoid 
burning  the  patient.  Persons  who 'have  carelessly  used  these  treat- 
ments have  sometimes  sacrificed  lives  by  improper  methods  of  appli- 
cation. The  use  of  "home"  methods  by  the  patient  alone  necessitates 
a  labor  that  should  be  performed  by  another,  to  say  nothing  of  the  risk 
of  conflagration  and  personal  burning.  Private  homes  have  no  facil- 
ities for  after-treatment,  nor  is  the  temperature  of  the  room,  as  a  rule, 
kept  sufficiently  high  to  prevent  evil  consequences  following  its  use. 
It  is  the  writer's  firm  belief  that  apparatus  using  gasoline,  kerosene, 
alcohol  and  others  of  this  group  should  be  used  in  private  homes  with 
great  care,  and  never  countenanced  in  public  sanatoria. 

Hot-Air  Cabinet. — The  apparatus  is  constructed  of  wood,  prefer- 
ably of  three  layers.  The  inner  perpendicular  layer  of  lumber  is  best 
made  of  tongue  and  grooved  poplar,  upon  which  is  tacked  asbestos; 
over  this  a  thin  sheet  of  poplar  is  nailed  horizontally,  another  layer  of 
tar  or  heavy  building  paper  added  and  a  second  perpendicular  row  of 
tongue  and  grooved  poplar  screwed  upon  the  outside.  The  floor, 
four  sides  and  the  stationary  part  of  the  top  are  to  be  so  constructed, 
the  whole  to  be  painted  inside  and  out  with  fireproof  white  paint. 
Upon  one  side  a  narrow  perpendicular  door  (or  two)  swings  upon 
hinges  just  wide  enough  for  a  person  to  comfortably  enter  the  cabinet 
and  sit  upon  a  stool,  which  should  have  a  revolving  seat  so  that  it  can 
be  raised  and  lowered  to  accommodate  the  patient.  In  the  top  a 
circular  hole  is  cut  of  proper  dimensions  to  permit  of  the  head  re- 
maining outside  the  cabinet  and  a  loose  removable  board  to  allow  of 
the  patient  taking  his  seat,  after  which  it  can  be  adjusted  comfortably 


80  PRACTICAL  HYDROTHERAPY. 

around' the  neck.  My  own  predilection  is  for  the  use  of  the  steam- 
pipe  radiator,  and  I  thoroughly  agree  with  Baruch  that  this  is  by  far 
the  best  and  simplest  method  for  applying  heat  in  the  hot-air  cabinet. 
Of  course,  heat  may  be  forced  into  the  cabinet,  but  from  a  practical 
standpoint  the  former  is  much  preferred.  A  large  excess  of  radiating 
steam  coil  surface  should  be  placed  in  the  cabinet,  as  it  is  a  very  easy 
matter  to  reduce  temperature  when  it  is  desired.  As  a  matter  of 
economy,  if  it  is  so  desired  and  the  bath  has  been  properly  constructed 
as  above  outlined,  it  can  be  used  for  a  Russian  vapor  cabinet  as  well, 
all  that  is  necessary  being  to  have  an  open  pipe  or  several  openings  by 
means  of  which  the  steam  may  enter  the  cabinet.  I  have  never  favored 
the  use  of  steam,  nor  do  I  consider  the  Russian  bath  a  valuable  one,  but 
from  experience  restrict  my  work  to  hot  air  and  radiant  energy. 

The  patient,  nude,  enters  the  cabinet  and  seats  himself  comfortably 
upon  the  stool  so  that  his  chin  is  just  above  the  outside  level  of  the 
cabinet.  The  attendant  adjusts  the  loose  boards  snugly,  and  also  wraps 
a  large  Turkish  towel  around  the  neck  to  prevent  escape  of  heat, 
which  would  reduce  the  temperature  of  the  bath  and  also  be  exceed- 
ingly unpleasant  to  the  patient.  The  door  is  closed,  the  steam  turned 
into  the  radiating  coil  and  the  cabinet  gradually  heated  to  such  a  point 
as  is  desired.  The  temperature  may  be  controlled  by  means  of  a  valve 
which  permits  of  a  larger  or  smaller  quantity  of  steam  entering  the 
coil.  The  patient's  head  should  be  enveloped  in  a  wet  cloth,  turban 
or  ice  helmet.  The  usual  temperature  of  such  a  bath  ranges  from 
150°  to  200°  F.  and  its  duration  depends  entirely  upon  the  case  in 
hand.  Where  stimulation  is  desired  it  should  be  continued  until  per- 
spiration is  barely  detectable;  if,  on  the  contrary,  the  full  effects  here- 
tofore described  are  to  be  obtained,  it  should  be  continued  until  free 
perspiration  takes  place.  The  main  difference  and  distinction  between 
the  action  of  this  and  the  Turkish  bath  is  that  the  patient  inhales  cool 
fresh  air  while  the  surface  of  his  body  is  exposed  to  the  heat.  Owing 
to  the  fact  that  hot  air  is  not  inhaled,  the  cabinet  is  somewhat  slower 
in  its  action  than  that  of  the  Turkish  bath,  and  much  safer. 

Turkish  Bath. — In  the  Turkish  bath  the  bather  enters  the  dressing 
room,  removes  the  clothes,  and,  throwing  a  sheet  around  him,  prepares 
to  enter  the  hot-air  room.  He  should  first  wet  the  face  and  hair  of  the 
head  thoroughly  and  drink  at  least  one  or  two  glasses  of  cold  water. 
He  then  enters  the  hot-air  room  and  lies  down  upon  a  couch.  For  a 
few  moments  there  is  a  sensation  of  oppression,  but  usually  by  the  end 
of  from  five  to  fifteen  minutes  he  begins  to  perspire  and  relief  is  ex- 
perienced. The  air  of  this  room  is  most  frequently  heated  by  steam 
coils,  and  in  this  respect  is  most  unhygienic  and  disagreeable,  as  the 
different  persons  entering  the  room  are  more  or  less  compelled  to 
inhale  the  contaminating  air  of  the  chamber.  The  best  method  of 
heating  is  with  currents  of  hot  air,  by  means  of  which  ventilation  is 


Pl.te   29-Superheated    Dry    Hot   Air;    Local   Application;    Foot    Bandaged    in 
Plate  &     supern  <Turkisl/Toweling  Ready  to  be  Introduced. 


Plate  30-Superheated  Dry  Hot  Air ;  Treating  Foot. 


Plate  31— Superheated  Dry  Hot  Air;  Treating  Hand  and  Arm. 


Plate  32— Superheated   Dry   Hot  Air:   Treating  Knee  with  Special  Apparatus 

for  this  Joint. 


ASSOCIATED  PROCEDURES.  81 

secured  and  fresh  hot  air  introduced,  it  being  the  idea  of  modern 
furnace  heating.  The  hot  air  should  enter  at  a  point  several  feet  below 
the  ceiling,  and  the  foul  air  vents  that  carry  away  the  impurities  be 
located  near  the  floor.  Users  of  the  Turkish  bath,  should  they  fail  to 
perspire,  must  at  once  leave  the  hot-air  room,  as  injury  may  be  sus- 
tained by  too  long  exposure  to  such  intense  heat  without  the  safety 
valve  of  perspiration,  there  being  danger  of  heat-stroke  taking  place. 
Most  Turkish  baths  have  a  second  or  very  hot  room  whose  temperature 
ranges  from  140°  to  180°.  After  free  perspiration  has  been  induced, 
the  bather  may  enter  for  a  few  moments  the  very  hot  temperature 
above  mentioned  in  order  to  induce  vigorous  or  excessive  perspiration. 
From  this  chamber  he  enters  the  shampoo  room,  is  placed  upon  a  slab 
of  marble  with  a  rubber  air-pillow  under  his  head.  The  attendant 
usually  commences  by  dipping  his  hands  in  very  hot  water,  rubbing 
the  entire  cutaneous  surface  with  his  hands  alone.  He  then  shampoos 
the  bather  with  soap,  commencing  with  the  upper  extremities  and 
systematically  going  over  the  entire  body.  This  may  be  done  with  a 
brush  of  hair,  rubber,  flax  or  other  fibrous  material.  This  process  is 
continued  until  all  the  superficial  epidermis  has  been  removed  and  the 
skin  feels  smooth  and  slick.  The  attendant  then  uses  a  small  hose  to 
which  a  nozzle  with  many  perforations  is  attached  to  remove  the  soap 
and  cleanse  the  body.  He  then  proceeds  to  knead  and  roll  the  muscles 
of  the  upper  and  lower  extremities  and  trunk,  after  which  he  again 
sprays  the  patient,  gradually  reducing  the  temperature  of  the  water  to 
about  80°.  The  bather  is  then  conducted  to  the  douche,  which  may  be 
either  the  rain  bath,  circular  needle  or  jet,  and  given  a  short  vigorous 
cold  application.  He  is  then  quickly  rubbed  down,  a  sheet  is  thrown 
around  him  and  he  enters  the  cooling  room ;  here  the  attendant  starts 
with  the  head  and  carefully  dries  the  hair,  then  in  succession  the 
extremities  and  trunk.  It  is  likely  that  there  will  be  secondary  per- 
spiration after  the  patient  enters  the  cooling  room.  If  there  is  much 
difficulty  in  drying  the  hair,  or  perspiration  continues,  an  alcohol  rub 
is  frequently  added.  The  patient  should  remain  in  the  cooling  room 
until  he  is  perfectly  dry  and  pulse  and  respiration  have  reached 
the  normal.  He  dresses  slowly  and  avoids  exertion  for  some  time 
after  the  bath. 

The  Turkish  bath  is  a  powerful  procedure,  and  with  the  strong 
it  may  be  used  twice  weekly ;  with  the  feeble  never  more  than  once 
a  week.  This  bath  is  a  very  ancient  one,  and  was  the  bath  of  all 
others  most  in  vogue  by  the  Romans,  the  ruins  of  whose  thermae 
to-day  give  some  idea  of  the  immense  extent  to  which  this  luxurious 
race  utilized  the  bath.  This  is  especially  true  of  the  thermae  of  Cara- 
calla,   which   have   heretofore   been    described. 

The  Russian  Bath. — The  Russian  bath  is  usually  given  in  Turkish- 
bath  establishments,  a  room  being  set  apart  for  this  purpose.     In  my 


82  PRACTICAL  HYDROTHERAPY. 

opinion,  ir  is  the  least  valuable  of  all  methods  of  applying  heat  by 
conduction.  In  this  bath  the  patient  lies  upon  a  marble  slab  in  a 
small  room  filled  with  the  vapor  of  steam.  The  temperature  is  usu- 
ally kept  between  115°  and  125°  F.  It  will  be  noted  that  the  bather 
cannot  stand  high  moist  temperatures;  in  fact,  135°  or  140°  F.  is 
trying  to  most  persons.  The  bather,  lying  upon  the  slab,  is  rubbed 
by  the  attendant  with  a  view  of  stimulating  an  active  flow  of  per- 
spiration. The  same  rules  that  are  applicable  to  the  Turkish  bath 
with  regard  to  preparation  and  after-treatment  apply  with  equal  force 
to  the  Russian  bath. 

Superheated  Dry  Hot  Air.— The  use  of  this  measure  is  of  recent 
date,  and  was  first  introduced  about  ten  or  twelve  years  ago  in  England, 
through  what  is  known  as  the  "Tallerman-Schemeld  local  hot  air  bath." 
The  writer  has  before  him  the  original  communication  (London  Lancet) 
with  regard  to  this  method,  and  it  is  interesting  to  note  the  improve- 
ments that  have  been  made  in  technique,  apparatus  and  results,  but 
justice  must  be  done  in  giving  credit  to  the  original  idea  of  these 
workers.  To-day  many  kinds  of  apparatus  are  upon  the  market 
for  the  local  and  general  application  of  high  temperatures  of  dry 
hot  air,  but  those  used  by  the  author,  whose  cuts  are  shown  here- 
with, have  always  given  him  satisfaction  and  most  excellent  results. 
The  essential  basis  of  construction  in  the  local  as  well  as  body  appa- 
ratus is  an  arrangement  by  means  of  which  very  high  temperatures 
of  hot  air  may  be  made  to  circulate  through  a  cylinder  composed  of 
copper,  steel  or  other  metal.  The  apparatus  is  so  constructed  that 
applications  may  be  made  to  the  body  or  extremities  without  the 
part  coming  in  contact  with  the  heated  metal  of  the  cylinder. 

In  local  .applications,  the  part  is  carefully  wrapped  in  Turkish 
toweling  and  covered  with  a  glove  or  stocking  made  out  of  the  same 
material.  It  is  then  placed  in  the  hot-air  apparatus  upon  a  stand, 
made  usually  of  asbestos,  the  curtains  being  carefully  drawn  around 
the  limb,  so  as  to  prevent  the  escape  of  heat.  In  practice  the  gas 
jet  is  first  lighted  and  the  apparatus  allowed  to  warm  up ;  the  limb 
is  then  introduced  as  above  described,  and  allowed  to  remain  from 
thirty  to  sixty  minutes,  after  which  it  is  removed  and  treated. 

The  body  apparatus  made  by  Betz  is,  in  my  opinion,  the  best 
apparatus  upon  the  market,  and.  as  is  seen  in  the  picture,  it  is  a 
metal  cylinder  with  a  stretcher  board  rolling  upon  a  metal  track. 
In  practice  the  patient,  wearing  a  Turkish  bath-robe,  slips  on  a  pair 
of  mits  an:!  stockinettes  made  out  of  Turkish  toweling,,  a  sheet  of  sim- 
ilar material  is  wrapped  around  him  and  then  run  in  the  cylinder, 
the  apron  neatly  tucked  and  adjusted  around  the  neck,  and  a  wet 
turban  or  ice  helmet  placed  upon  the  head,  which  is  made  com- 
fortable with  the  pneumatic  pillow.  The  gas  jets  are  then  lighted 
(the  writer  uses  natural  gas)  and  the  valves  in  the  top  opened.     The 


Plate  33 — Superheated   Dry   Hot   Air;   Treating-   Hip. 


Plate  34 — Superheated  Dry  Hot  Air;  Treating  Back. 


ASSOCIATED  PROCEDURES.  83 

temperature  of  this  hath,  to  obtain  the  best  results,  should  range 
between  -'40  and  300  F.,  a  fair  average  being  275°.  Certain 
facts  should  be  borne  in  mind  in  the  technique,  one  of  which  is  to 
be  liberal  in  wrapping  the  body  and  extremities  for  these  applications. 
Water  must  be  accessible,  so  that  the  patient,  should  it  he  deemed 
advisable,  can  drink  freely.  The  head  is  kept  cool  and  the  face 
sponged.  Women  may  wear  the  gutta-percha  cap,  so  that  the  hair 
will  not  become  dampened,  and  upon  the  forehead  and  around  the 
neck  a  cold  compress  is  applied.  Every  endeavor  should  he  made 
to  make  the  patient  comfortable.  See  that  the  chair  or  lounge  in 
local  applications  i^  at  the  right  height  and  producing  no  strain  upon 
other  joint>;  in  the  body  apparatus  spare  no  pains  to  secure  proper 
and  comfortahle  elevation  of  the  head.  Do  not  permit  hot  air  to 
stream  over  the  patient's  face.  In  plethoric  men  and  women  a  cold 
compress  around  the  neck  is  a  valuable  aid  in  relieving  oppression. 
If  there  is  no  special  reason  for  doing  otherwise,  the  patient  should 
lie  upon  the  back,  but  wdiere  the  aim  is  to  treat  conditions  involving 
the  spine  or  back  muscles  the  patient  may  recline  upon  the  abdomen. 
It  is  advisable  from  time  to  time  to  raise  the  limbs  without  uncovering 
them,  in  order  to  secure  free  circulation  of  the  hot  air  about  the  en- 
tire person.  The  duration  of  this  bath  ranges  from  twenty  to  sixty 
minutes,  with  temperatures  of  240°  to  300°.  When  the  treatment  is 
over  the  apron  is  thrown  aside  and  the  stretcher  rolled  out  to  its  full 
length.  It  is  generally  my  plan  to  then  permit  the  patient  to  recline 
upon  the  sofa  or  massage-table  for  a  few  moments.  Usually  there  is 
a  fresh  accession  of  perspiration  upon  leaving  the  apparatus.  At 
this  point,  general  massage,  vibration,  etc.,  may  be  applied.  The 
author,  when  using  the  body  apparatus,  never  uses  either,  but  prefers 
to  have  the  patient  enter  a  needle  or  circular  rain  bath  at  a  tem- 
perature of  100°,  wdiich  is  gradually  reduced  until  sufficient  heat 
abstraction  has  taken  place.  Reaction  occurring,  the  patient  is  then 
rubbed  down,  and  allowed  to  rest  until  perfectly  dry.  It  has  been 
my  experience  that  these  treatments  are  most  successful  when  exer- 
cise is  not  taken  immediately  after  them,  but  rather  they  should  be 
succeeded  by  rest.  First  treatments  should  be  of  short  duration,  so 
that  we  may  have  an  opportunity  of  studying  the  patient's  reactive 
capacities.  Increase  gradually  each  succeeding  treatment.  Many 
patients  can  bear  much  higher  temperatures  where  the  head  and  neck 
are  kept  cool,  and  it  may  be  reiterated  here  that  comfort  soon  over- 
comes nervous  dread  and  apprehension.  It  is  astounding  sometimes 
what  tactful  management  of  cases  will  do  to  overcome  a  patient's 
fears. 

Therapeutics. — There  is  a  wide  therapeutic  field  for  this  method  in 
many  kinds  and  classes  of  diseases.  Care  should  be  taken,  however,  to 
investigate  carefully  the  condition  of  the  circulation,  heart  and  respira- 


84  PRACTICAL  HYDROTHERAPY. 

tion.  Many  cases  that  can  stand  the  hot-air  cabinet  and  superheated  dry 
hot  air  cannot  endure  or  gain  benefit  from  the  use  of  the  Turkish  or 
Russian  bath. 

Superheated  dry  hot  air  is  not  as  good  a  method  as  the  electric 
light  bath  for  warming  patients  before  the  use  of  cold  applications. 
This  is  equally  true  of  the  steam  vapor  cabinet.  In  rheumatism,  gout, 
arthritis  and  the  uric  acid  diathesis  it  should  be  more  utilized  than 
it  is  at  the  present  time,  especially  where  followed  by  hydriatic  meas- 
ures which  tend  to  produce  tonic  conditions  of  the  circulation. 

The  Turkish  bath  and  body  apparatus  of  superheated  dry  hot  air 
are  excellent  methods  for  the  reduction  of  obesity,  and  the  author  has 
obtained  benefit  in  diabetes  from  their  use,  combined  with  Swedish 
resistive  exercises.  In  diseases  of  the  kidney,  where  these  organs  are 
crippled  and  elimination  is  defective,  superheated  dry  hot  air  has 
yielded  me  results  far  beyond  my  anticipations,  though  care  should 
be  exercised  in  subsequent  cooling.  In  constitutional  blood  states, 
metallic  poisoning,  scrofula  and  syphilis,  excellent  results  may  be 
expected.  Superheated  dry  hot  air  has,  in  my  hands,  given  results 
more  nearly  resembling  the  hot  springs  of  this  country  and  Europe 
than  any  other  treatment.  In  general  infective  conditions,  in  acute 
inflammations  of  the  lung,  pleura,  intestines,  etc.,  superheated  dry  hot 
air  is  indicated.  In  chronic  nervous  diseases,  neurasthenia,  hysteria, 
neuritis,  neuralgia,  functional  rather  than  organic  troubles  are  bene- 
fited by  the  hot-air  cabinet  and  superheated  dry  hot  air.  Nervous 
patients  do  not,  as  a  rule,  stand  the  Turkish  bath  well,  but  take  the 
same  temperatures,  where  the  head  is  exposed,  with  impunity.  In 
myelitis  the  judicious  use  of  dry  hot  air  is  valuable,  but  I  wish 
to  enter  a  strong  protest  against  the  use  of  these  measures  in  loco- 
motor ataxia,  spinal  and  cerebral  paralysis,  etc.  Chronic  dyspeptics 
of  all  kinds  are  helped  by  hot  air  or  superheated  dry  hot  air ;  the 
anemic  and  chlorotic  also.  For  the  elimination  of  mercury  there  is 
nothing,  in  my  mind,  comparable  to  the  action  of  the  body  apparatus 
and  the  incandescent  electric  light  bath.  As  a  means  of  preserving 
health,  strengthening  the  resistive  powers  against  the  encroachment 
of  disease,  and  for  overcoming  the  results  of  a  sedentary  life,  these 
methods  are  of  considerable  value. 

The  local  application  of  superheated  dry  hot  air  has  proved  by 
far  the  most  satisfactory  means  for  the  treatment  of  the  joint 
affections  that  accompany  gout,  acute  or  chronic  articular  rheumatism, 
synovitis,  fibrous  ankylosis,  sprains,  rheumatoid  arthritis,  joint  tuber- 
culosis, etc.  In  localized  infections  its  influence  is  almost  marvelously 
curative. 


Plate  35— Hot  Air  Cabinet. 


Plate  36 — Hot  Air  Cabinet  in  Use. 


CHAPTER  VI. 
MINOR  HYDROTHERAPEUTIC  METHODS. 

The  methods  described  in  this  chapter  have  in  themselves  only 
moderate  curative  value,  and  are  therefore  classified  by  me  as  "minor 
hydrotherapeutic  methods.**  They  are,  however,  very  useful  for  the 
temporary  relief  of  localized  inflammation  and  functional  pain.  Many 
are  daily  utilized  by  the  laity,  who  apply  them  without  consultation 
with  the  physician.  They  possess  little,  if  any,  systemic  influence. 
The  commonest  application  is  that  of  heat,  which  may  be  applied  by 
means  of  the  hot-water  bag,  bottle,  jug,  sand-bag,  salt-bag,  bran-bag, 
bricks,  blocks  of  wood,  stove  lids,  flat  irons  and  coil — in  fact,  almost 
any  way  in  which  heat  can  be  retained.  All  objects  used  should  be 
wrapped  before  applying  The  immediate  effect  of  localized  heat  is 
to  gradually  raise  the  temperature  of  the  part  brought  in  contact 
with  it,  the  part  to  which  heat  is  applied  being  warmed  to  a  consid- 
erable depth.  Circulation  is  increased  and  the  temperature  slightly 
raised  by  dilatation  and  increased  activity  of  the  blood  currrent. 
Metabolism  is  stimulated,  exudation  and  suppuration  favored.  Its 
action  upon  the  nervous  system  is  that  of  a  sedative,  relieving  pain 
by  its  combined  influence  upon  the  cutaneous  nerves,  relieving  pres- 
ure  and  relaxing  muscles. 

Local  cold  effects  are  the  reverse  of  those  of  heat,  with  some  few 
exceptions.  The  local  application  of  cold  does  not  influence  the  gen- 
eral body  temperature  nor  produce  general  effects.  It  reduces  the 
temperature  of  the  part  until  it  reaches  that  of  the  thermic  medium, 
lessening  the  circulation  in  the  part,  reducing  temperature  by  con- 
tracting the  blood-vessels  and  slowing  the  blood-stream.  Exudation, 
pus  formation  and  metabolism  are  retarded.  Upon  the  nervous  sys- 
tem cold  may  likewise  produce  a  sedative  influence,  due  to  its  numb- 
ing action  upon  the  nerves  within  the  skin.  Especially  in  those  pain- 
ful states  produced  by  localized  inflammations  we  may  expect  con- 
siderable relief  from  the  application  of  cold.  There  is  one  localized 
application  of  cold,  however,  that  may  produce  a  general  lowering  of 
the  temperature,  and  this  is  the  much-used  cerebral  coil  or  coil  cap. 
This  consists  of  a  thin  rubber  basis  upon  which  is  wound  a  rubber 
tube  through  which  the  water  flows.  The  cap  is  adjusted  to  the  head. 
The  general  reduction  of  tempertaure  is  due  to  its  influence  upon 
the  thermogenetic  centers  located  within  the  brain.  This  is  one  of 
the  reasons  why  it  tends  to  lower  temperature  in  meningitis,  in  addi- 
tion to  its  localized  action  as  an  abstractor  of  heat. 
(85) 


86  PRACTICAL  HYDROTHERAPY. 

Heat  and  cold  may  both  be  applied  to  any  part  by  simply  wrapping 
around  a  small  rubber  hose  attached  to  a  proper  reservoir  which 
permits  the  flow  of  water  through  the  tube.  All  localized  applications 
of  heat  and  cold  are  better  tolerated  where  a  thin  compress  is  placed 
between  them  and  the  skin. 

Chapman's  Methods  and  Bags. 

At  the  head  of  minor  hydrotheraeputic  measures  stands  the  appli- 
cation of  ice  and  hot  water  to  the  spine,  first  brought  to  notice  by  Dr. 
John  Chapman,  of  Paris,  France.  I  had  the  pleasure  of  knowing 
Dr.  Chapman  during  my  sojourn  in  Paris  in  1889,  and  was  in  this  way 
early  brought  in  close  touch  with  his  ideas  and  work.  From  time 
to  time  since  then  I  have  utilized  his  methods.  My  own  experience 
with  regard  to  the  efficacy  of  his  treatment  is  to  substantiate  the  prop- 
osition laid  down  by  him  in  his  works,  but  I  have  so  far  not  been 
able  to  secure  the  curative  results  that  he  claims  for  the  persistent 
application  of  the  method.  The  essential  feature  is  the  use  of  a  single-, 
double-  or  three-compartmented  rubber  ice-bag,  these  compartments 
being  superimposed  upon  one  another  with  the  idea  of  preventing 
the  accumulation  of  ice  at  the  lower  part  of  the  bag  alone.  These 
bags  are  of  sufficient  width — say  about  four  inches — to  cover  the  en- 
tire spinal  area,  embracing,  as  he  says,  the  spinal  cord  itself  and  the 
sympathetic   ganglia   lying  adjacent   to   it. 

The  sympathetic  system  consists  of  a  series  of  ganglia  connected 
together  by  intervening  cords,  extending  on  each  side  of  the  vertebral 
column  from  the  base  of  the  skull  to  the  coccyx.  There  are  a  num- 
ber of  ganglia  of  this  character  associated  with  the  cranial  nerves. 
Each  ganglion  may  be  regarded  as  a  center  from  which  branches  and 
impulses  pass  in  various  directions.  These  ganglia  are  intimately 
connected  with  the  organic  processes  of  life,  and  follow  the  blood- 
vessels to  their  finest  ramifications.  The  cut  gives  at  once  a  bird's-eye 
view  of  the  distribution  and  physiological  association  of  sympathetic 
nerves.  Independent  functions  are  found  in  connection  with  the 
nerve  plexuses  formed  by  the  junction  of  numerous  branches  of 
nerve  fibers  into  a  central  ganglion  in  different  localities.  These 
nerves  and  plexuses  are  connected  intimately  with  the  central  nervous 
system.  They  govern  the  so-called  organic  functions  of  the  heart, 
abdominal  viscera,  especially  those  of  the  stomach,  intestine,  uterus, 
Fallopian  tubes,  etc.  It  will  be  borne  in  mind,  however,  that  as  far 
as  its  vasomotor  function  is  concerned  this  is  derived  from  the  cen- 
tral nervous  system  and  passed  into  the  plexuses,  and  that  the  nerves 
originating  from  the  plexus  carry  these  impulses  to  the  terminal 
blood-vessels. 

It  is  Chapman's  theory  that  ice  applied  in  rubber  bags  of  the  right 


Plate  37 — Chapman's  Spiral  Ice  Bags  ;   Chapman's   Double  Column   Spinal  Hot 
Water  Bag;  Ordinary  Hot  Water  Bottle. 


MINOR  HYDROTHERAPEUTIC  METHODS.  87 

length  and  proper  width,  placed  over  the  sympathetic  centers  located 
in  the  spinal  column,  dilates  the  arterioles  controlled  by  the  said  cen- 
ters, arrests  hypersecretion  of  glandular  organs,  checks  spasmodic 
and  irregular  muscular  movements  of  the  voluntary  and  involuntary 
muscles,  and  by  its  sedative  action  upon  trophic  centers  arrests  hyper- 
nutrition.  The  action  of  heat  is  diametrically  opposed,  viz.,  it  con- 
tracts the  arterioles,  increases  the  secretion  from  the  glandular  sys- 
tem, increases  muscular  movement,  voluntary  and  involuntary,  and 
by  its  action  upon  the  trophic  centers  increases  nutrition.  He 
says:  "But  as  the  sympathetic  and  cerebro-spinal  nervous  systems  are 
so  intimately  related,  and,  indeed,  inextricably  and  undistinguishably 
blended,  both  in  structure  and  function,  the  nervous  influence,  whether 
in  health  or  not,  which  is  exerted  becomes  abnormal,  either  in  kind 
or  degree,  the  most  satisfactory  method  of  restoring  it  to  its  healthy 
condition  would  be  by  a  dual  action  at  once  on  the  sympathetic  and 
cerebro-spinal  nervous  systems." 

Chapman  states  his  pathology  as  follows :  "That  the  so-called  func- 
tional diseases  of  any  viscus  are  abnormal  conditions  of  the  nervous 
ganglia  which  control  it,  and  that  these  diseases  are  most  safely,  most 
easily  and  most  evidently  remedied  by  action  not  on  the  viscus  itself, 
not  by  medicine  presumed  directly  to  influence  it,  but  by  decreasing  or 
increasing  the  quantity  of  blood  in  those  nerve  centers  by  which  its 
blood-vessels  are  governed." 

In  practice  the  patient  lies  upon  the  ice-bag  for  periods  varying 
from  one  to  two  or  three  hours  in  duration,  according  to  the  severity 
of  the  condition.  It  must  be  borne  in  mind  that  this  is  not  a  method 
for  the  local  effect  of  cold.  Cold  is  not  disagreeable,  as  I  have 
frequently  demonstrated  upon  myself.  The  application  of  heat  is 
accomplished  by  a  double-column  hot-water  bag  with  an  intervening 
space  between  the  columns,  the  heat  being  applied  upon  either  side 
of  the  spinal  column  itself.  The  temperature  of  the  water  should 
be  between  115°  and  120°  F.,  and  may  be  applied  for  the  same  lengih 
of  time  as  the  ice-hag.  Its  greatest  range  of  action  lies  in  functional 
nervous  diseases,  and  Chapman  recommends  this  for  nervous  pros- 
tration, headache,  migraine,  insomnia,  indigestion,  vomiting,  consti- 
pation, leucorrhea.  bronchorrhea,  asthma,  hay  fever,  etc.  It  is  claimed 
by  him  to  be  useful  in  the  treatment  of  neuralgias,  especially  of  the 
face.  I  cannot  agree  with  him  in  the  uses  and  value  of  this  treatment, 
but  it  has,  in  my  hands,  yielded  some  results  in  the  treatment  of  in- 
somnia, in  which  condition  the  application  of  a  dorso-lumbar  ice-bag 
has  frequently  produced  drowsiness.  This  can  be  increased  by  the 
application  of  the  hot-water  bag  to  the  "cilio-spinal  region" — that 
is  to  say,  from  the  fourth  cervical  to  the  third  or  fourth  dorsal  of  the 
cord.  As  before  stated,  these  applications  have  aided  me  in  the  pro- 
duction  of   sleep,   but   I   have   never  been   able   to   demonstrate   their 


88  PRACTICAL  HYDROTHERAPY. 

curative  power.     They,  however,  are  excellent  measures   for  tempo- 
rary relief. 

Friction. 

Friction  may  be  defined  as  the  mechanical  act  of  rubbing  the  cuta- 
neous surface.  It  may  be  performed  by  the  hand,  flesh-brush,  or 
flesh-mitten,  but  the  first  of  these  is  far  preferable  to  any  other  form. 
It  is  synonymous  with  the  word  shampoo  as  used  in  medicine.  It  may 
be  applied  by  the  individual  or,  preferably,  by  an  attendant.  The  or- 
dinary manner  of  its  application  is  to  rub  the  skin  surface  with  the 
bare  hand,  preferably  in  both  directions.  The  condition  and  sensi- 
tiveness of  the  particular  individual  in  question  will  decide  the  depth 
and  pressure  used  as  to  whether  it  will  be  light  or  vigorous.  Avoid 
applying  such  an  amount  of  friction  as  would  irritate  the  skin  or 
abrade  it.  Nothing  is  gained  by  rough  or  irritating  treatment.  This 
is  much  more  likely  to  occur  where  a  brush  is  used  than  where  the 
hand  is  interposed.  Where  the  hand  or  brush  has  been  used  too 
much,  superficial  redness  and  irritation  are  apt  to  follow.  Too  vigorous 
application  defeats  its  own  object,  and  has  a  tendency  to  exhaust  and 
tire  the  patient.  See  that  the  hand  is  perfectly  dry.  Where  it  is 
used  simply  to  assist  the  circulation,  it  may  be  applied  only  in  the  di- 
rection of  the  venous  blood  current — that  is,  toward  the  heart.  The 
first  influence  of  friction  upon  the  cutaneous  surface  is  a  very  pleasant 
one,  its  momentary  action  being  to  temporarily  constrict  the  capillary 
circulation,  but  after  it  has  been  kept  up  for  a  short  time  dilatation  of 
the  blood-vessels  occurs,  and  it  is  for  this  reason  that  friction  favors 
reaction.  The  volume  of  the  circulation  is  considerably  accelerated, 
with  a  moderate  increase  of  the  pulse.  Owing  to  the  mechanical 
action  of  friction  and  to  the  dilatation  of  both  the  arterial  trunks  and 
capillaries,  there  is  a  slight  rise  in  temperature,  together  with  an  in- 
creased production  of  heat,  a  fact  that  is  clinically  utilized  in  the 
Brand  bath,  the  half  bath  and  the  dripping  sheet.  Winternitz  dis- 
covered that  active  friction  of  the  skin,  combined  with  the  application 
of  cold  water,  increases  temperature  reduction,  this  being  accom- 
plished by  bringing  a  larger  quantity  of  blood  to  the  surface,  circu- 
lating in  contact  with  cold  water.  This  dilatation  of  the  blood-vessels 
is  very  marked  in  some  instances,  and  can  be  cultivated  by  the 
repeated  use  of  friction. 

The  influence  of  friction  upon  the  skin  is  a  valuable  one,  stimula- 
lating  it  to  secrete  more  actively  of  perspiration,  and  particularly  of 
the  oily  constituents  connected  with  the  sebaceous  glands.  It  tends 
to  produce  a  soft,  flexible  and  smooth  skin ;  it  also  increases  the  hairy 
growth,  and  care  should  be  exercised  in  this  direction.  The  therapeutic 
uses  to  which  friction  may  be  applied  form  a  part  of  every  massage 
treatment.     It  is  a  splendid  preparatory  procedure  to  cold  water,  and 


Plate  38 — Friction  with  Flesh  Brush. 


MINOR  HYDROTHERAPEUTIC  METHODS.  89 

where  one  does  not  have  hand}-  the  electric  light  or  hot  air  hath  this 
may  be  used  with  the  same  object  in  view.  It  is  useful  as  a  pre- 
liminary for  those  cases  who  are  confined  to  their  room,  and  with 
whom  we  would  use  the  dripping  sheet  or  some  similar  method.  To 
the  hydriatist  it  is  the  hest  of  all  means  for  the  favoring  of  reaction, 
and  should  never  be  omitted  from  any  method  where  this  is  desired. 
Applied  to  cold  extremities  it  stimulates  circulation.  I  will  have  more 
to  say  regarding  its  use  when  considering  the  physiological  action  of 
the  Brand  bath  in  typhoid  fever. 

Sand  Baths. 

I  have  never  utilized  this  method  of  treatment  in  my  practice,  but 
have  incidentally  tried  and  observed  its  action  at  the  seashore.  I  do  not 
consider  sand  nor  mud  baths  to  possess  any  special  therapeutic  value 
over  ordinary  hydriatic  methods.  They  do  not,  in  any  sense,  compare 
to  the  application  of  radiant  heat,  such  as  the  electric  light  bath.  Of 
these  baths  Winternitz1  has  to  say  the  following: 

"Originally  sand  heated  by  the  sun  was  employed,  but  the  method 
has  been  accelerated  in  recent  years,  especially  by  Dr.  Sturm,  of 
Kostritz,  and  by  Grawitz.  of  Berlin,  and  its  indications  have  been 
defined.  At  present  artificially  warmed,  fine,  hard  sea  or  river  sand 
is  used,  the  heating  being  effected  in  ovens  especially  constructed  for 
the  purpose.  In  the  tub— a  quadrangular  wooden  box  upon  rollers — 
is  placed  a  layer  of  hot  sand  from  15  to  30  cm.  (  six  to  twelve  inches) 
high,  and  upon  this  the  patient  lies.  With  the  exception  of  the  head, 
which  is  elevated,  the  body  is  covered  with  sand,  and  finally  with 
warm  blankets.  The  floor  of  the  cabinet  is  generally  made  of  sheet- 
iron,  and  is  heated  by  means  of  tubes  placed  below7.  The  sand  has  a 
temperature  of  from  45°  to  50°  C.  (113°  to  122°  F.),  and  even  a 
temperature  of  53°  C.  ( 127.4°  F. )  is  well  borne.  The  pulse,  it  is 
true,  becomes  accelerated,  as  in  the  case  of  other  methods  of  over- 
heating the  entire  body ;  and  also  the  respiration  is  quickened,  but 
serious  discomfort  is  exceptional.  The  head  must  ahvays  be  well 
cooled.  Sweating  occurs  rapidly,  and  becomes  abundant,  as  the  sand 
exerts  a  hygroscopic  influence,  and  favors  the  secretion  of  sweat. 
The  sand  bath  is  continued  from  one-half  to  one  and  one-half  hours." 

Salt  Rub. 

The  application  of  salt  to  the  cutaneous  surface  has  been  practiced 
for  years  by  eminent  hydriatists.  Medium  fine  salt  is  moistened  with 
sufficient  water  to  produce  a  mushy  mixture,  after  which  it  is  taken 
in  the  hand  of  the  attendant  and  applied  to  the  surface  of  the  body 
with  circular  friction  movements.  Care  should  be  taken  to  rub  gently 
and  slowly  so  as  to  prevent  scratching  or  abrasion  of  the  skin,  as  some 
individuals  are  exceedingly  sensitive  to  the  scratching  influence  of 
this  chemical.     Persons  with  a  dark,  tough  cutis  may  be  rubbed  vigor- 

1   Winternitz,   Wm. :     "Cohen's    Systeir    of   Physiological   Therapeutics."    Vol.    IX,    1902. 


90  PRACTICAL  HYDROTHERAPY. 

ously  until  they  begin  to  feel  strongly  its  action  upon  the  integument. 
The  water  used  to  moisten  the  salt,  and  the  salt  itself,  should  be  kept 
at  such  a  temperature  as  will  avoid  chilling  of  the  surface.  In 
sanatoria  these  applications  are  made  in  properly  heated  treatment 
rooms,  and  thus  it  is  not  necessary  to  exercise  as  much  care  to  prevent 
chilling.  Where  the  patient  is  weak  he  may  sit  or  recline  during  its 
application.  Considerable  amounts  of  the  salt  will  stick  to  the  skin, 
and  if  it  is  permitted  to  dry  will  produce  an  itchy  feeling.  Its  applica- 
tion may  be  followed  by  any  hydriatic  method  suited  to  the  particular 
case.  The  patient  can  then  be  dried  and  gently  rubbed  with  the  hand 
to  favor  reaction.  After  the  application  of  the  salt  rub  the  skin  feels 
smooth  and  glossy,  a  great  deal  like  the  condition  following  a  Turkish 
bath,  due  to  the  removal  of  several  layers  of  the  epidermis.  The 
physiological  action  of  the  salt  upon  the  skin  is  that  of  a  chemical, 
thermic  and  mechanical  irritant.  Under  it-  use  the  skin  becomes 
redder  and  more  vascular.  Its  application  alone  resembles  the  salt 
water  bath,  and  is  quite  tonic  and  stimulating.  Care  must  be  used 
with  sensitive  neurasthenics.  It  is  a  valuable  introductory  method  to 
other  hydriatic  procedures,  and  is  particularly  beneficial  in  those  cases 
who  have  dry.  harsh  and  leather-like  skins.  In  some  cases  of  digestive 
and  renal  inactivity  this  measure  is  an  excellent  derivative.  I  have 
found  it  to  render  service  in  removing  localized  pains  of  a  neuralgic 
and  rheumatic  type  when  situated  in  the  muscles  and  joints.  I 
frequently  prescribe  the  incandescent  electric  light  bath  with  localized 
application-  of  salt  to  painful  spots,  these  measures  to  be  followed  by 
some  general  hydriatic  treatment. 

Oil  Rub. 

From  most  ancient  until  the  present  time  oil  lias  been  used  as  a 
method  of  treatment  after  the  use  of  the  bath.  It  will  be  recalled  that 
one  of  the  divisions  of  the  Roman  bath  was  that  of  the  unctorium, 
where  oils  were  "rubbed  in.*'  It  is  a  constant  practice  with  semi- 
civilized  and  barbaric  races  to  use  oil  after  the  bath,  for  protective 
and  cosmetic  purposes.  The  best  oil  to  apply  to  the  surface  is  a 
vegetable  one.  and  for  this  purpose  cocoanut  and  olive  oil  have  proved 
the  best  in  my  hands.  Cocoa  butter  and  vaseline  may  subserve  the 
purpose,  especially  the  former.  From  an  esthetic  standpoint  the 
addition  of  a  little  oil  of  rose  is  not  objectionable.  Care  should  be 
exercised  in  securing  fresh  preparations,  and  seeing  that  there  is  not 
the  least  degree  of  rancidity.  The  best  method  of  application  is  by 
means  of  the  palmar  surfaces  of  the  fingers  and  hand.  It  should  be 
applied  to  the  skin  after  a  thorough  cleansing  bath.  The  skin  must 
be  dry  and  free  from  perspiration.  This  must  not  be  considered  a 
greasing  process,  but  the  oil  is  to  be  gently  and  patiently  rubbed  into 


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MINOR  HYDROTHERAPEUTIC  METHODS.  {)\ 

the  skin.     Unguents  are  net  applied  to  the  skin   for  the  purpose  of 
nourishment. 

Some  of  the  effects  associated  with  massage  are  inseparable  from 
the  application  of  the  oil  rub.  ( )il  rubbing  is  an  exceedingly  pleasant 
and  agreeable  process  where  it  is  gently  practiced.  Its  action  upon 
the  skin  is  to  soften  and  make  flexible  this  organ.  It  is  sedative  and 
is  to  be  recommended  for  those  cases  who  are  so  sensitive  as  to  pre- 
clude the  use  of  salt  or  vigorous  dry  friction.  "The  natives  of 
Samoa  and  other  south  sea  islands,  who  are  great  swimmers,  habitu- 
ally smear  themselves  with  oil  before  entering  the  water.  On  the 
other  hand,  heat  radiation  by  the  skin  is  very  considerably  increased 
by  the  application  of  oil.  Peclat  has  shown  (  Schumann )  that  an 
oil  surface  radiates  heat  50  per  cent,  more  rapidly  than  a  water 
surface.  The  natives  of  Africa,  when  exposing  their  mule  hodies  to 
the  dry  rays  of  the  tropical  sun,  habitually  protect  themselves  by 
smearing  the  skin  with  melted  fat  of  some  sort."     (Kellogg.) 

Attention  may  be  called  to  the  fact  that  the  Sandwich  Islanders, 
who  are  probably  the  greatest  swimmers  known,  not  only  smear  them- 
selves with  unguents  while  in  the  water,  but  should  one  of  their 
members  become  fatigued  utilize  friction  to  overcome  this. 

The  therapeutic  application  of  oils  to  the  surface  is  narrow  and 
limited.  It  finds  its  greatest  use  in  those  persons  whose  skins  are 
harsh  and  dry  because  of  a  lack  of  sufficient  natural  oil  in  the  seba- 
ceous glands.  Children  seem  to  be  more  favorably  affected  by  oil 
rubbing  than  the  adult,  though  I  am  rather  constrained  to  believe 
that  it  is  more  particularly  the  massage  or  rubbing  than  the  physio- 
logical action  of  the  oil.  In  the  vigorous  massage  of  localized  con- 
ditions it  is  preferable  to  use  some  oil  to  prevent  chafing  and  irritation. 
Many  writers  suggest  the  use  of  oil  of  some  kind  to  the  hair  after 
the  use  of  soap.  Patients  whose  reactive  capacity  is  limited  gain 
some  benefit  from  the  application  of  oil  rubbing  after  the  bath  is  over. 

The  Electric  Bath. 

The  electric  bath  is  only  used  in  the  treatment  of  such  morbid 
conditions  as  affect  the  whole  system,  and  provides  a  convenient 
though  unsatisfactory  way  of  applying  electricity.  Electrification  has 
a  powerful  influence  upon  the  body,  and  is  useful  in  the  treatment  of 
general  morbid  states  and  in  diseases  due  to  impaired,  defective  nutri- 
tion. The  temperature  of  the  water  should  be  about  98°  F.,  but  it 
may  be  slightly  warmer  or  cooler  to  suit  the  wishes  of  the  patient ;  a 
bath  thermometer  must  always  be  used  to  ascertain  and  regulate  the 
temperature.  The  bath-tub  itself  may  be  porcelain-lined,  metal,  papier 
mache  or  wood,  with  two  electrodes  in  the  form  of  metal  plates  at 
the  head  and  foot.  These  plates  must  be  kept  scrupulously  clean  and 
the  wires  attached  by  binding  posts.     The  water  in  the  bath  offers  a 


92  PRACTICAL  HYDROTHERAPY. 

broad  conducting  medium  several  times  larger  than  the  patient,  and 
therefore  a  considerable  part  of  the  current  traversing  the  water  is 
lost  to  the  patient,  this  being  particularly  true  of  the  galvanic  bath. 

In  the  use  of  the  galvanic  current  care  must  be  taken  to  gradually 
allow  the  electricity  to  enter  the  tub  until  the  milliamperemeter  reg- 
isters from  100  to  150.  Of  this  Stevenson  and  Jones2  calculate  that 
the  patient  only  receives  from  18  to  24  milliamperes.  The  best 
batteries  to  use  are  those  of  the  Laclanche  type,  and  of  these  I  have 
found  the  Gonda  the  best  on  the  market.  Forty  should  be  connected 
with  a  switch-board  having  a  milliamperemeter,  rheostat,  pole  changer, 
and  binding  post.  The  faradic  coil  may  be  added  should  the  physician 
desire  the  combined  galvano-faradic  current. 

The  patient  enters  the  bath  and  rests  a  few  minutes  to  recover 
from  the  reaction  produced  by  the  action  of  the  warm  water  before 
the  current  is  turned  on.  Gradually  and  slowly  increase  the  current, 
watching  the  meter  until  the  proper  dosage  is  reached.  It  is  best 
for  a  medical  man  to  be  present  when  the  galvanic  current  is  used, 
although  a  well-trained  nurse  will  usually  be  able  to  conduct  the 
seance;  if  it  is  necessary  for  a  medical  man  to  be  present  in  the  case 
of  ladies  a  bathing  costume  should  be  worn.  I  formerly  used  the 
electric  bath  considerably,  and  at  that  time  had  it  so  arranged  that  the 
battery  and  switch-board  were  in  an  adjoining  room;  a  speaking- 
tube  was  carried  to  the  bath-room  and  the  current  was,  in  this  way, 
regulated.  It  is,  however,  best  for  the  physician  to  be  present  and  in 
the  room  while  the  galvanic  current  is  flowing. 

A  wet  turban  or  ice  helmet  should  be  placed  upon  the  head  and 
care  exercised  not  to  take  the  bath  too  soon  after  a  full  meal.  The 
action  of  the  electric  currents  is  to  redden  the  nape  of  the  neck,  which 
gradually  passes  off  after  a  short  while.  The  alternating  current  or 
induction  coil  may  be  used,  the  alternating  current  producing  a 
smoother  sensation,  the  rise  and  fall  of  the  individual  impulses  being 
less  abrupt  than  with  the  coil.  The  induction  coil  current  throws  the 
abdominal  muscles  into  action  more  readily  than  the  galvanic  current, 
and  generally  produces  more  muscular  contraction.  No  one  should 
attempt  the  giving  of  an  electric  bath  from  the  "mains"  unless  he  be 
what  very  few  medical  men  are — an  expert  electrician.  The  sinusoidal 
current  may  be  used  in  like  manner. 

The  therapeutic  uses  of  the  electric  bath  are  those  of  a  general 
tonic,  and  it  finds  its  uses  mostly  in  states  of  debility.  Some  have 
found  it  of  value  in  alleviating  the  distress  connected  with  the  dis- 
continuance of  morphine.  Many  have  lauded  this  bath  as  a  means  of 
increasing  appetite,  digestion  and  assimilation,  and  have  obtained  re- 
sults far  different  from  my  own  experience.  After  several  years' 
experience  with  this  bath  I  have  discontinued  it  as  one  of  my  thera- 

2   Stevenson  and  Jones:    "Medical    Electricity."    1895,   p.   268. 


MINOR  I IV DROTHERAPEUTIC  METHODS.  93 

peutic  weapons.  It  is  described  here  in  order  that  the  work  may  be 
complete,  and  not  from  any  desire  to  laud  the  method,  which  I  consider 
of  little  or  no  value.  If  electrization  is  what  is  aimed  at,  there 
are  so  many  more  special  methods,  general  and  local,  of  obtaining 
results  in  this  line  that  I  heartily  condemn  the  hydro-electric  method. 
It  has  been  the  bath  par  excellence  of  the  quack  heretofore,  and  while 
it  has  been  removed  from  that  particular  domain  by  the  scientific 
researches  of  both  Hydel3  and  Hedley,4  still  hydriatists  in  this  country 
who  have  other  methods  that  they  may  use  rarely,  if  ever,  turn  to  the 
electric  bath. 

Steam. 

Steam  and  the  vapor  from  boiling  water  have  been  used  for  years 
by  the  physician  and  laity  for  the  purpose  of  inhalation.  This  is,  in 
reality,  not  steam  inhalation,  but  is  the  inhalation  of  air  saturated  with 
moisture  and  warmed  by  the  admixture  of  steam.  It  can  be  produced 
from  the  so-called  croup  kettle,  but  also  obtained  as  steam  in  those 
houses  that  are  provided  with  steam  heaters.  As  a  rule,  heat  is  inhaled 
for  a  short  time,  at  certain  periods  during  the  twenty-four  hours,  and 
there  is  no  question  but  what  this  agent  has  given  great  comfort 
and  alleviated  the  suffering  of  hundreds  of  persons  affected  with 
acute  and  chronic  conditions  of  the  air-passages.  The  action  of 
steam  upon  the  air-passages  is  that  of  localized  heat,  heretofore  de- 
scribed and  needless  to  be  repeated  again.  In  catarrhal  conditions 
of  the  nose  and  throat  it  finds  its  most  useful  application.  Relief  from 
inflammatory  conditions  of  the  throat  may  be  obtained  by  the  inhala- 
tion of  air  passed  through  an  ordinary  inhaling  bottle,  the  hot  water 
of  which  is  saturated  with  compound  tincture  of  benzoin.  One  of 
the  great  objections  to  Its  use  is  the  necessity  of  its  frequent  repeti- 
tion. The  ordinary  duration  of  an  inhalation  should  be  about  ten 
minutes.  Its  action  is  decidedly  soothing  and  relaxing;  it  aids  and 
improves  the  circulation  in  the  part  to  which  it  is  applied.  I  have 
never  seen  any  permanent  benefit  derived  from  its  application  to 
chronically  inflamed  tissues  of  the  upper  air-passages. 

Another  method  of  treatment  consists  in  the  inhalation  of 
steam  from  a  receptacle  to  which  it  is  conducted,  and  of  such  shape 
that  the  entire  head  may  be  exposed.  Around  the  head  a  towel  is 
thrown,  the  steam  inhaled  thus  being  brought  simultaneously  in  contact 
with  the  skin  of  the  face  and  the  mucous  membrane  of  the  air- 
passages.  The  stimulating  influence  of  heat  internally  is  reinforced 
by  the  active  vascular  dilatation  that  takes  place  within  the  skin  surface 
thus  exposed,  draining  the  collateral  circulation.  Relief  is  frequently 
experienced  in  a  few  moments.     After  the  administration  care  should 


3  Hydel,   L. :   "Die   Electrische   Bader,"   1896. 

4  Hedley:    "Hydro-Electric    Methods   in    Medicine,"    1892. 


94  PRACTICAL  HYDROTHERAPY. 

be  taken  to  avoid  the  inhalation  of  cooled  or  cold  air.  The  external 
application  of  cold  water  to  the  face  and  neck  following  such  a  method 
of  treatment  will  decidedly  prolong  and  enhance  the  blood  vascular 
effects  obtained. 

It  is  the  custom  with  writers  upon  hydrotherapy  to  include  within 
the  domain  of  such  a  work  a  description  of  lavage,  enteroclysis, 
vaginal  and  vesical  irrigation.  I  have  frequently  felt  that  while  these 
were  truly  hydrotherapeutic  applications,  still  it  did  not  seem  to  me  as 
though  they  belong  to  the  true  domain  of  works  of  this  kind,  but  rather 
are  methods  of  therapeutics  limited  to  particular  specialties.  The 
author  therefore  refrains  from  describing  these  procedures,  and  refers 
the  reader  to  works  upon  diseases  of  the  stomach  and  intestines, 
surgery  and  gynecology,  wherein  will  be  found  proper  descriptions  of 
the  technique  and  the  aims  and  objects  to  be  accomplished. 


CHAPTER  VII. 

RULES,  REGULATIONS  AND  PRACTICAL  SUGGESTIONS. 

Even  with  a  mastery  of  the  principles,  a  thorough  acquaintance 
with  the  technique  and  apparatus,  there  still  remain  certain  practical 
suggestions  that  are  the  result  of  long  experience  and  the  handling 
of  many  cases  and  classes  of  disease.  For  this  reason  it  has  seemed 
proper  to  me  that  they  should  he  laid  before  any  one  contemplating 
the  use  of  hydrotherapy  as  a  method  of  treatment. 

Probably  the  most  important  principle  in  the  guidance  of  hydriatic 
treatment  is  to  treat  the  patient  in  hand,  the  condition  and  not  the 
disease  with  which  he  has  been  tagged.  Given  a  number  of  patients  suf- 
fering from  the  same  disease,  and  we  will,  if  we  intelligently  study  each 
individual,  change  and  modify  the  treatment  to  meet  the  particular 
necessity  of  each  case.  Furthermore,  it  should  be  constantly  kept  in 
mind— and  that  clearly,  too— that  there  is  resident  in  the  patient's 
body  a  vital  force,  the  vis  medicatrix  naturae,  which,  if  it  can  be 
called  into  play,  will  cure. 

It  is  a  condition  precedent  to  success,  before  commencing  a  course 
of  hydrotherapy,  that  the  physician  should  be  in  possession  of  all 
facts  regarding  his  patient.  By  this  I  do  not  mean  a  haphazard  and 
loosely  conducted  examination,  but  a  full  clinical  history,  a  thor- 
ough examination  of  heart,  lungs,  and  especially  the  peripheral  blood- 
vessels, supplemented  by  an  analysis  of  the  blood,  urine,  and.  where 
necessary,  the  gastric  juice,  blood-pressure  tests,  etc.  In  considering 
the  clinical  history  of  a  case  due  weight  must  be  given  to  the  nervous 
system,  studying  the  vasomotor  indications  and  needs.  It  is  by  just 
such  careful  and  painstaking  examinations  that  we  avoid  the  un- 
pleasant effects  of  hydrotherapeutic  applications.  I  recall  with  pleas- 
ure that  in  an  experience  covering  eighteen  years  I  have  had  few 
disagreeable  results  follow  an  application  of  this  remedy,  and  believe 
that  this  has  been  the  case  simply  because  the  rules  here  laid  down 
have  been  followed. 

The  physician  is  the  only  person  by  whom  the  treatment  is  to  be 
mapped  out  in  all  its  details  and  technique,  though  the  hearty  and  intel- 
ligent co-operation  on  the  part  of  the  trained  nurse  and  attendant 
will  materially  aid  in  securing  results.  In  a  nurse  implicit  obedience 
is  an  excellent  trait  of  character,  and  implicit  obedience,  tempered  with 
a  little  judgment,  aids  in  securing  results.  Xurses  in  the  hydriatic 
department  of  sanatoria  soon  learn  how  to  handle  patients  who  come 
(95) 


96  PRACTICAL  HYDROTHERAPY. 

into  their  hands,  and  are  able  to  note  degrees  and  differences  of 
reaction  that  are  valuable  to  the  changing  of  hydriatic  prescriptions. 
Every  nurse  to  whom  these  cases  are  entrusted  should  know  thor- 
oughly the  changes  that  constitute  reaction. 

Should  the  detailed  examination  show  the  patient  suffering  from 
some  form  of  organic  trouble,  especially  some  structural  disease  of 
the  kidney  (Bright's  disease),  care  must  be  exercised  to  arrange  the 
hydriatic  prescription  with  regard  to  the  application  of  cold  water. 
The  timid  neurasthenic  and  hysteric  must,  by  patience,  assurance  and 
reassurance,  be  convinced  of  the  advantages  that  accrue  from  this 
treatment.  These  patients  are,  as  a  rule,  deficient  in  will  power  and 
capacity,  and  are  apt  to  form  aversions  to  certain  kinds  of  treat- 
ment, even  when  carefully  graduated  to  their  needs.  The  thin 
and  the  fat  need  different  methods,  and  their  physical  states  should 
be  taken  into  consideration  in  our  prescription.  The  physically 
weak  and  exhausted  should  receive  careful  attention,  as  they  have 
less  muscular  tissue  for  the  generation  of  heat,  and  are,  as  a  rule, 
anemic  and  toxic. 

In  the  management  of  those  chronically  invalided,  who  have  run 
the  gamut  of  medicinal  therapeutics,  whose  systems  are  more  or  less 
saturated,  so  to  speak,  with  medicines,  time  becomes  an  element  of 
necessity  in  their  treatment.  Too  frequently  I  am  consulted  and 
asked  if  a  few  weeks'  course  of  treatment  can  overcome  long-standing 
ailments.  The  system  has  become  warped,  pernicious  habits  and 
conditions  of  life  formed,  which  not  only  have  to  be  changed,  but  a 
sufficient  length  of  time  allowed  to  establish  physiological  reactions 
and  rhythms,  and  this  cannot  be  changed  and  adjusted  in  a  few  weeks' 
time.     It  is  often  a  question  of  months. 

Of  all  the  classes  of  patients  that  seek  the  hydriatist's  aid,  the 
most  difficult  to  handle  and  those  in  whom  more  caution  has  to  be 
exercised,  is  the  class  suffering  from  the  symptom-complex  called 
neurasthenia.  They  are  sick  all  over,  nervous,  impressionable,  irri- 
table, dyspeptic,  toxic,  with  skins  that  are  strangers  to  cold  water. 
Caution  must  be  exercised  in  the  inception  of  any  method. 

The  hydriatist  should  pay  particular  attention  to  arterial  sclerosis 
when  placing  his  patients  upon  treatment.  Age  is  not  measured  by 
years,  but  by  cardio-vascular  conditions,  some  persons  being  older  at 
thirty  than  others  at  sixty.  Especial  care  in  cases  of  this  kind  should 
be  insisted  upon,  as  there  is  serious  danger  of  the  rupture  of  a  brittle 
or  weakened  blood-vessel,  and  as  these  vessels  are  usually  more 
commonly  present  in  the  brain,  the  danger  of  a  cerebral  apoplexy 
should  not  be  overlooked. 

For  esthetic  reasons  alone  hydriatists,  as  a  rule,  forego  the  use 
of  baths  during  the  menstrual  period.  There  exists  in  the  minds  of 
the  laity  a  conviction  that  is  firm  and   immovable  that  baths   should 


RULES.  REGULATIONS  AND  SUGGEST IONS.  97 

be  discontinued  or  forbidden  during  this  period.  This  is  not  limited 
alone  to  the  ignorant  and  uneducated,  but  is  prevalent  among  well- 
read  and  enlightened  members  of  the  community.  Physiology  fur- 
nishes  no  basis  upon  which  to  form  such  an  hypothesis,  and  physicians 
are  largely  to  blame  for  having  nurtured  this  belief,  which  is  due  to 
ignorance  of  natural  laws.  I  have  read,  though  I  am  unable  to  put 
my  hand  upon  the  authority,  that  upon  the  Massachusetts  coast  is  a 
colony  of  sturdy  fisher  people  whose  women  enter  the  sea  during  the 
menstrual  period,  even  during  the  dead  of  winter,  without  the  slight- 
est ill  effects.  While  this  extreme  is  not  applicable  to  the  delicate 
and  hot-house  nurtured  individual  of  the  present  generation,  still  it 
is  true  that  they  can  be  readily  trained  to  endure  without  discomfort 
and  with  much  benefit  the  application  of  cold  baths  at  this  time.  As 
an  actual  fact,  water  stimulates  intrapelvic  circulation,  and  thus  cor- 
rects and  counteracts  irregular  and  deficient  menstruation.  The  time- 
worn  and  hoary  legend  that  the  contact  of  cold  water  to  the  skin 
during  the  menstrual  period  will  cause  cessation  of  the  flow,  is  a  relic 
of  bygone  days,  and  a  reminder  of  the  infancy  of  this  treatment,  be- 
fore the  principles  and  physiology  of  the  action  and  reaction  of  cold 
water  were  studied  or  appreciated. 

Hydriatic  treatment  should  not,  as  a  rule,  be  administered  imme- 
diately after  a  meal,  but  a  period  of  at  least  one  hour  or  one  hour 
and  a  half  be  allowed  to  intervene.  As  before  stated,  I  have  found 
the  best  period  for  administration  of  these  methods  of  treatment  to  be 
during  the  forenoon,  preferably  two  hours  after  breakfast  and  up  to 
within  a  half  or  one  hour  of  lunch  or  dinner. 

Metabolism  should  be  carefully  studied  and  the  patient's  weight 
watched,  whether  the  aim  is  constructive  or  destructive.  Much  in- 
formation as  to  the  general  internal  changes  that  take  place  may  be 
gained  from  the  feelings  of  the  patient.  An  improvement  in  appe- 
tite, muscular  strength,  and  that  feeling  described  by  our  Gallic  neigh- 
bors as  bien  faisancc,  constitute  an  excellent  index.  The  solid  con- 
stituents of  the  urine  often  give  valuable  aid,  an  excess  of  solids,  es- 
pecially the  chlorides,  indicating  increased  tissue  breakdown,  while 
an  excess  in  urea  points  to  destructive  metabolism  taking  place  in  the 
muscles,  demanding  a  regulation  of  exercise  and  hydriatics. 

Extreme  exhaustion  contraindicates  the  use  of  cold  applications. 
In  these  cases  fatigue,  chilliness,  blueness  of  the  extremities  and 
cold  sweat  may  be  present.  Under  such  conditions  it  should  be  our 
aim  to  bring  about  reaction  by  the  application  of  heat  and  heating 
procedures,  and  when  this  is  fully  established  a  brief  stimulating 
and  tonic  application  of  cold  can  be  made  to  ensure  permanency. 

Organic  diseases  are,  of  course,  from  their  very  nature,  incurable, 
but  there  are  comparatively  few  organic  diseases,  excepting  in  the  latest 
stages,  that  have  totally  destroyed  the  function  of  any  organ  or  part. 


98  PRACTICAL  HYDROTHERAPY. 

It  has  been  my  observation  that  the  judicious,  proper  and  painstaking 
application  of  suitable  hydrotherapeutic  applications  prevent  degen- 
eration and  check  further  encroachment.  It  frequently  occurs  that 
if  the  remaining  tissues  are  undisturbed  by  the  process  they  will  take 
up  the  work,  and  thus  a  part  may  be  made  to  perform  the  work  of  the 
whole.  It  is  common  sense  as  well  as  sound  logic,  that  whatever  in- 
creases vital  force,  improves  vigor  and  resistance,  is  certainly  going 
to  be  a  bar  to  further  deterioration  and  incapacity. 

It  may  be  noted  again  that  reaction  is  that  appearance  of  bright 
red  color,  an  agreeable  glow  and  sense  of  well-being  that  follows  the 
application  of  cold.  All  nurses  follow  cold-water  treatment  by  mod- 
erate friction  to  hasten  reaction. 

In  order  to  avoid  disagreeable  and  ill  effects  of  cold  applications 
to  the  general  surface,  it  is  always  well  to  carefully  train  the  patient's 
reactive  powers,  collecting  heat  upon  the  surface  and  making  the 
first  cold  application  at  a  moderate  temperature,  say  80°  F.,  reducing 
the  temperature  two  or  three  degrees  or  more  daily,  as  reactive  ca- 
pacity develops.  Never  use  strong  measures  at  the  start,  but  gradually 
work  up  from  the  milder  to  the  stronger,  from  higher  to  lower  tem- 
peratures, for  by  so  doing  much  of  the  difficulties  experienced  by 
patients  in  these  treatments  can  be  avoided.  As  the  patient  reacts  to 
each  successive  reduction  of  temperature,  he  soon  becomes  able  to 
stand  a  temperature  that  would  have  been  impossible  and  attended 
with  danger  had  it  been  utilized  at  the  start.  The  aim  of  tonic  hydro- 
therapy is  cold,  and  very  cold,  temperatures  (65°  to  45°  F.),  for  it 
is  from  these  temperatures  that  the  most  satisfactory  and  favorable 
effects  are  obtained.  Reaction  in  nervously  exhausted  cases  is  best 
attained  by  brief,  stimulating,  cold  applications. 

Preliminary  or  preparatory  treatment  for  cold  temperatures  is  im- 
portant, and  must  be  carefully  studied  by  the  hydriatist.  The  electric 
light  bath,  hot-air  cabinet,  vapor  cabinet,  salt  rub,  friction  or  physical 
activity  sufficient  to  produce  slight  perspiration,  favor  prompt  and 
tonic  response  and  the  onset  of  reaction. 

Imperfect  reaction  is  a  disagreeable  phenomenon  that  can  attend 
the  application  of  cold.  This  is,  in  the  highest  degree,  an  injury,  and 
indicates  failure  to  attain  our  object.  The  nurse  first  applies  vigorous 
friction,  assisted  by  the  patient,  for  muscular  exercise  favors  reac- 
tion ;  should  this  fail,  the  patient  must  be  wrapped  in  blankets,  hot- 
water  bags  placed  to  the  feet,  and  very  hot  water  sipped  slowly.  By 
this  means  imperfect  reaction  will  be  overcome.  Where  reaction 
takes  place  and  it  is  not  sufficient,  it  can  be  increased  by  moderate  ex- 
ercise after  the  bath.  The  disagreeable  after-effects  of  cold  applica- 
tions are,  generally,  fatigue,  muscular  aching,  lassitude,  headache,  de- 
pression, palpitation  of  the  heart,  irritability,  and  an  increase  in  local- 
ized painful  conditions. 


RULES,  REGULATIONS  AND  SUGGESTIONS.  99 

Habit  is  the  result  largely  of  neural  responses  to  certain  impres- 
sions. Patients  who  have  never  formed  the  habit  of  using  anything 
but  hot  water  have  missed  the  pleasurable  portion  of  bathing,  and 
these  individuals  must  be  trained  to  stand  colder  temperatures  ;  whereas, 
those  who  have  been  accustomed  to  the  use  of  cold  water  may  fre- 
quently be  at  once  subjected  to  radical  treatment,  for  in  these  the 
neural  and  vasomotor  mechanisms  are  habituated  and  trained  to  those 
prompt  responses  that  are  the  essential  and  basic  part  of  reaction. 

The  best  time  of  day  for  the  administration  of  hydriatics  is,  in 
my  opinion,  between  the  hours  of  9  A.M.  and  3  p.m.  Certain  proce- 
dures are  best  given  before  breakfast,  others  at  bedtime,  but,  taking 
the  vast  bulk  of  tonic  treatments,  we  may  say  that  the  above  hours 
are  the  best.  In  the  treatment-rooms  located  in  large  cities  it  is  not 
an  uncommon  thing  to  give  treatment  in  the  evening,  and,  while  this 
practice  is  objectionable,  it  is  better  than  no  treatment  at  all,  but  it 
is  certainly  second  or  third  best. 

Care  and  attention  should  be  given  to  the  temperature  of  the  treat- 
ment-rooms. The  bath-room  must  be  kept  warm,  and,  in  my  opinion, 
80°  F.  even  is  not  too  hot.  By  this  means  the  comfort  of  the  patient 
is  conserved  and  the  warm  temperature  favors  reaction.  After  the 
patient  has  been  thoroughly  dried,  he  should  return  to  the  rest-  or 
dressing-rooms,  which  are  kept  at  a  much  more  hygienic  temperature. 

It  may  be  set  down  as  axiomatic  that  the  colder  the  water  the 
shorter  the  duration ;  the  colder  the  application  the  more  vigorous 
should  be  the  percussion.  Where  this  is  borne  in  mind,  excellent  re- 
sults are  obtained.  For  very  cold  applications  (34°  to  55°  F.)  the 
duration  should  not  be  over  three  to  five  seconds,  applied  under  con- 
siderable pressure;  where  the  temperature  is  cold  (55°  to  650^F.)  the 
duration  may  be  extended  to  a  maximum  of  twenty  seconds ;  while 
for  cool  applications  (65°  to  80°  F. )  they  may  last  as  long  as  one-half 
to  three-quarters  of  a  minute.  If  temperature-reducing  effects  are 
aimed  at,  however,  this  rule  will  not  hold  good,  but  the  application 
must  be  kept  up  for  fifteen  to  twenty  minutes  and  be  attended  with 
friction.  In  the  administration  of  neutral  methods  in  order  to  obtain 
sedation  it  is  necessary  that  the  application  should  be  from  twenty 
to  sixty  minutes.  Under  some  circumstances  these  applications  have 
been  continued  for  days  and  weeks,  notably  in  the  series  of  cases  pub- 
lished by  Reiss.  As  before  stated,  the  aim  of  neutral  applications  is 
the  avoidance  of  thermic  reaction. 

What  is  true  of  cool,  cold,  and  very  cold  applications  is  also  true 
of  warm  (96°  to  98°  F.),  hot  (98°  to  104°  F. )  and  very  hot  (104°  F. 
and  above )  applications — that  is  to  say,  very  hot  applications  should 
be  of  short  duration,  rarely  exceeding  half  a  minute,  while  the  hot 
and  w-arm  applications  may  be  correspondingly  prolonged. 

Just  as  white  looks  whiter  upon  a  black  background,  so  we  may 


100  PRACTICAL  HYDROTHERAPY. 

obtain  more  stimulating  and  revulsive  effects  if  we  alternate  tern- 
peratures,  and  this  is  particularly  true  when  alternation  is  accom- 
panied with  considerable  pressure.  Where  stimulation  of  this  kind 
is  desired,  and  it  is  deemed  expedient  to  make  the  application,  heat 
should  always  be  the  temperature  first  applied.  It  can  usually  be 
borne  from  104°  to  120°  F.,  lasting  from  fifteen  to  thirty  seconds, 
and  followed  by  a  very  cold  application  (55°  to  40°  F.)  for  three 
to  five  seconds,  again  the  hot  application,  then  the  cold.  By  this 
means  we  obtain  very  powerful  reactions.  My  personal  experience 
has  been  that  there  is  no  method  so  capable  of  relieving  deep-seated 
pain,  especially  of  fibrous  tissues  and  peripheral  nerves.  Applied  in 
this  manner  to  the  spine,  it  is  astonishing  what  a  mulittude  of  activi- 
ties are  reflexly  aroused,  and  what  far-reaching  and  satisfactory 
conditions  are  produced.  Stiffness  and  ankylosis  are  very  effectively 
overcome,  provided  they  fall  within  the  curable  category. 

When  the  dripping-sheet  and  non-percutient  methods  are  used, 
the  patient  must  stand  in  a  foot-tub  of  water,  as  hot  as  can  possibly 
be  borne.  This  does  away  with  shock,  is  a  comfort,  and,  while  a 
small  detail,  will  frequently  overcome  strenuous  objection  and  reluc- 
tance.    It  favors  reaction. 

Patients  frequently  experience  a  sense  of  constriction  and  weight 
upon  the  chest,  together  with  an  apparent  "shutting-off  of  the  wind," 
when  first  subjected  to  a  cold  application.  In  hunting  for  an  explana- 
tion of  this,  I  noticed  it  was  their  habit  to  keep  the  mouth  tightly 
closed,  breathing  only  through  the  nostrils.  This  can  be  easily  over- 
come by  merely  opening  the  mouth  wide  and  inhaling  deeply  when 
the  cold  water  strikes  the  surface. 

Many  cases  have  positive  harm  done  them  by  courses  of  treatment 
administered  at  popular  pleasure  resorts  or  mineral  springs.  These 
springs  are  usually  hot  salines,  and  the  patient  is  immersed  in  the 
hot  full  bath  for  periods  ranging  from  ten  to  thirty  minutes.  As  a 
result,  sedation  and  weakness,  together  with  a  considerable  break- 
down of  tissue,  take  place,  and  harm  is  done  to  the  bather.  This 
is  likewise  true  of  those  who  resort  too  frequently  to  the  Turkish 
or  Russian  bath. 

Mere  age  does  not  preclude  the  use  of  hydrotherapy  as  a  reme- 
dial agent,  but  does  determine  in  a  certain  way  the  kind  of  treat- 
ment, its  temperature,  duration  and  force  of  impact.  This  is  equally 
true  with  regard  to  the  young,  and  in  this,  as  in  a  number  of  other 
things  in  life,  extremes  meet,  and  the  same  rule  applies  for  the  child, 
the  infirm  and  the  elderly.  The  aged  and  the  young  cannot  stand 
extremes  of  temperature,  and  are  slow  to  react  at  all  times.  Care 
should  be  exercised  to7  examine  the  heart  from  time  to  time.  Chil- 
dren under  seven  years  of  age  do  not  well  bear  the  application  of 
very   cold   water,   and   the   douche   in   all    forms    should   be   avoided. 


RULES,  REGULATIONS  AND  SUGGESTIONS.         101 

The  daily  cold  bath  is  an  important  aid  to  general  development  in 
growing  children,  and  increases  muscular  vigor,  energy  and  nerve 
tone.  It  prevents  the  development  of  neuroses  in  young  persons 
just  entering  upon  puberty,  relieves  so-called  growing  pains,  and  pro- 
motes vigorous  and   normal   development. 

We  arc  frequently  told  by  patients  that  an  application  of  cold  to 
the  cutaneous  surface  results  in  a  slight  attack  of  rheumatism  or  a 
"fresh  cold."  These  pains  are  not,  as  is  commonly  supposed,  due  to 
the  shock  of  the  cold  water  or  to  catching  cold,  but  are  more  often  the 
result  of  the  setting  free  of  uric  acid  and  toxins  of  the  uro-toxic  group. 
These  are  absorbed  into  the  circulation,  produce  irritating  effects,  dull 
aching  pains  and  stillness.  It  has  been  my  habit  for  a  number  of  years 
to  be  careful  to  see  that  patients  are  dried  with  especial  thoroughness 
before  leaving  the  bath-room  during  the  winter  months.  They  should 
exercise  sufficient  care  to  see  that  the  skin  is  not  damp  before  exposing 
themselves,  for  the  colder  and  drier  air  of  winter  is  very  apt  to  cause 
rapid  evaporation  of  the  surface  moisture,  giving  rise  to  chilliness  and 
being  followed  by  the  so-called  "cold." 

Hydrotherapy  offers  to  those  in  health  an  excellent  and  effective 
method  for  the  maintenance  of  sound  and  physiological  function.  The 
average  human  has  a  pure  inherent  objection  to  the  use  of  cold  water, 
and  for  this  reason  is  apt  to  employ  neutral,  tepid  or  hot  baths  solely 
for  the  purpose  of  cleanliness,  thus  missing  a  great  deal  of  the  hygi- 
enic and  tonic  properties  of  the  bath.  Cold  water  is  a  tonic  to  both 
the  central  nervous  and  sympathetic  systems.  Cold  bathing  develops 
a  flexibility  of  the  vasomotor  system  and  a  vital  resistance  in  the 
skin.  I  know  of  no  better  way  of  preventing  or  overcoming  the 
tendency  to  "catch  cold"  than  the  cold  bath.  This  is  not  brought 
about  by  "closing  up  the  pores"  of  the  skin,  but  is  due  to  an  increase 
in  vital  resistance,  to  greater  flexibility  of  circulation  in  the  skin, 
and  the  ability  of  the  vasomotor  mechanism  to  respond  to  cold  im- 
pressions and  reheat  the  skin. 

It  is  an  interesting  fact  that  I  have  observed  time  and  time  again, 
that  patients  frequently  have  their  condition  very  much  aggravated 
during  the  first  few  weeks  of  treatment,  a  state  trying  to  them,  and 
a  period  during  which  the  physician  is  subjected  to  somewhat  of 
a  strain  in  maintaining  his  authority  and  retaining  their  confidence. 
This  is  especially  true  of  those  who  are  sick  all  over,  whose  every 
functon  is  involved,  and  who  have  little,  if  any,  vitality  as  a  margin 
upon  which  to  build.  This  includes  the  neurasthenic,  the  dyspeptic, 
lithemic,  the  so-called  ''chronic  invalid'*— in  fact,  the  flotsam  and 
jetsam  of  therapeutics.  At  first  the  problem  seems  peculiar,  and  to 
the  patient  distressing.  It  is  probably  due  to  the  fact  that  the  treat- 
ment has  thrown  toxic  material  into  the  blood  in  excess.  It  is  a  good 
plan,   therefore,   to   warn   patients   before   they    sta:t   that   they   may 


102  PRACTICAL  HYDROTHERAPY. 

experience  an  intensification  of  their  symptoms,  but  that  these  will 
disappear  with  perseverance  in  the  treatment.  Haig  explains  this 
condition  on  the  hypothesis  of  the  presence  in  the  blood  of  an  excess 
of  uric  acid  (uro-toxic  group),  and  that  the  increased  symptoms  will 
disappear  with  the  elimination  of  these  toxins.  This  is  doubtless, 
in  part,  true. 

The  ideal  progress  toward  recovery  is  the  gradual  and  steady  ces- 
sation of  symptoms  and  betterment  of  condition.  This  is  rarely  ob- 
tained. There  are  three  modes  of  recovery  under  the  application  of 
these  methods.  The  first  is  a  steady,  unbroken  and  satisfactory  prog- 
ress ;  the  second  a  zigzag,  irregular  course ;  and  the  third  in  which 
there  is  a  sudden  improvement  after  a  prolonged  perseverance  in  the 
treatment.  These  last  cases  obtain  results  by  a  sturdy  confidence  in 
their  physician,  a  courage  born  of  belief  in  his  capacity.  Xot  only 
is  it  necessary  for  the  patient  to  persevere  sufficiently  long  to  secure 
results,  but  it  is  essential  that  the  treatment  be  maintained  some  time 
after  recovery.  It  is  not  sufficient  to  simply  secure  an  amelioration 
or  disappearance  of  symptoms.  This  lack  of  care  on  the  part  of  the 
sick  to  secure  permanent  results  explains  many  of  the  relapses  re- 
corded against  certain  methods  of  treatment. 

Patients  who  have  been  chronic  invalids  for  a  long  time  have 
formed  pernicious  functional  habits,  and  after  recovery  are  more  liable 
to  the  action  of  the  causes  that  before  produced  the  disease.  For 
this  reason  they  should  exercise  every  hygienic  precaution,  and  among 
the  preventive  methods  is  the  use  of  cold  water  as  a  part  of  the  pa- 
tient's daily  life.  By  so  doing  he  is  able  to  guard  himself  against  the 
action  of  these  causes. 

Cases  frequently  do  not  receive  the  maximum  benefit  while  they 
are  under  the  immediate  care  of  the  hydriatist.  There  may  be  an 
amelioration  and  betterment  of  the  symptoms,  but  a  cure  does  not 
take  place  until  after  the  patient  returns  to  home  surroundings.  Thus, 
oftentimes,  hydrotherapy  is  not  given  its  full  meed  of  praise  for  the 
excellent  work  it  has  accomplished. 

The  majority  of  people  in  health,  and  especially  those  who  are 
sick,  have  to  be  coaxed  to  take  a  bath — that  is  to  say,  to  use  cold 
water.  Cold  water  usually  means  tepid,  and  very  few  of  their  own 
volition  use  a  temperature  under  80°  F.  These  cases  can  be  made 
to  respond  to  the  lowest  temperatures. 

Sedentary  persons  especially  need  the  benefit  of  the  cold  bath. 
Such  persons  may  advantageously  employ,  before  the  cold  douche, 
a  hot  bath  of  three  or  four  minutes'  duration.  Adults  who  are  pre- 
disposed to  rheumatism,  gout,  gravel,  migraine,  Bright's  disease,  neu- 
rasthenia, and  other  maladies  which  for  the  most  part  are  the  result 
of  the  retention  within  the  body  of  the  products  of  nitrogenous  waste, 
are  benefited  by  the  employment  of  the  cold  daily  bath.     Cold-water 


RULES,  REGULATIONS  AND  SUGGESTIONS.         103 

treatment  is  especially  useful  for  women  of  civilized  nations,  because 
of  the  deteriorating  influence  of  their  artificial  life.  The  harmful 
customs  of  civilization,  rather  than  nature,  have  made  woman  "the 
weaker  vessel."  The  cold  bath  gives  nerve  tone,  combats  nervous 
weakness,  is  a  most  excellent  prophylactic  against  hysteria,  and  to  a 
very  considerable  degree  overcomes  the  unwholesome  tendencies  of 
the  in-door  and  sedentary  life  to  which  most  women  are  subjected. 
The  cold  bath  favors  the  development  of  the  menstrual  function  in 
young  girls,  and,  if  habitually  employed,  normalizes  the  menopause. 

There  are  certain  groups  of  patients  whose  skins  are,  hydrothera- 
peutically  speaking,  foreign  to  water,  not  that  they  are  uncleanly. 
These  people  are  benefited  by  all  sweat-producing  methods  when  suf- 
ficiently prolonged.  The  heat  and  sweating  soften  and  loosen  the 
dead  and  horny  superficial  layers,  which  are  easily  removed  by  the 
subsequent  hydrotherapeutic  application  and  mechanical  friction.  As 
a  result,  the  openings  or  mouths  of  the  various  excretory  ducts  open- 
ing upon  the  skin  are  freed  from  their  superficial  coverings,  and  the 
accumulated  waste  material — fat,  dirt  and  dried  perspiration — re- 
moved. Opportunity  is  given  for  elimination,  which  these  cases  need 
so  badly. 

Persons  whose  sedentary  occupations  confine  them  largely  within 
doors,  who  work  a  great  deal  by  artificial  light,  can  maintain  health, 
tone  and  vigor  by  the  use  of  a  sweating  procedure  and  hydrotherapy 
twice  weekly.  I  know  of  no  more  pernicious  and  dangerous  method 
of  following  the  above  suggestion  than  the  use  of  the  so-called  "home 
vapor  cabinet."  The  trouble  does  not  lie  in  the  cabinet  or  in  the 
method,  but  the  individual  using  it  is  unwilling  to  follow  the  sweat- 
ing by  a  cold  application  of  sufficient  length  to  remove  from  the  skin 
the  increased  heat  imparted.  For  this  reason  there  is  no  vigorous 
thermic  and  circulatory  reaction,  the  real,  essential  object  aimed  at  in 
the  bath.  In  cold  applications  we  have  a  means  by  which  oil  may  be 
applied  to  the  wheels  of  human  health  and  the  machinery  made  to 
run  smoothly. 

One  of  the  most  valuable  and  interesting  of  all  the  actions  of  water 
in  therapeutics  is  the  influence  it  exerts  upon  the  circulation,  with  the 
resultant  reaction.  Where  the  effect  is  general  it  is  more  or  less 
valve-like  in  action,  drawing  a  large  quantity  of  blood  to  the  cutane- 
ous surface  from  the  interior  of  the  body,  especially  the  viscera. 
Nearly  all  disease  starts  in  a  disordered  circulation,  and  he  who  has 
control  of  any  means  by  which  he  can  influence  its  action  has  a  valu- 
able weapon  with  which  to  combat  and  cure  diseased  and  disordered 
states,  for  chronicity  is  oftentimes  maintained  by  circulatory  dis- 
turbances or  by  the  states  produced  in  the  body  dependent  upon  these 
disturbances.  Stasis  of  the  circulation  forms  a  favorable  nidus  or 
point  for  infection  or  the  development  of  metabolic  conditions  favor- 


104  PRACTICAL  HYDROTHERAPY. 

able  to  disease,  while,  on  the  contrary,  the  favoring  of  a  rapid  circula- 
tion and  the  passage  of  a  larger  quantity  of  blood  through  any  par- 
ticular organ  stimulates  its  function  and  regeneration. 

In  the  anemic,  care  should  be  exercised  to  precede  all  hydriatic 
treatment  by  some  heating  procedure.  In  my  hands  the  electric  light 
bath  has  yielded  the  best  results,  the  patient  being  kept  in  this  long 
enough  to  heat  the  skin  thoroughly,  or  until  perspiration  is  barely 
perceptible  to  the  touch.  Better  results  will  be  obtained  if  the  full 
strength  of  the  bath  is  used  for  a  short  period. 

Acute  inflammatory  conditions,  as  a  rule,  contraindicate  the  use 
of  stimulating  or  percutient  measures ;  chronic  inflammatory  condi- 
tions, notably  those  of  neuralgia,  myalgia,  chronic  rheumatism  and 
chronic  neuritis  (especially  of  the  sciatic  nerve),  require  strong  and 
vigorous  ones  to  bring  about  the  desired  result. 

Secondary  sedation  of  the  nervous  system  is  nearly  always  obtained 
through  the  influence  of  hydrotherapy,  but  where  direct  sedative  ac- 
tion is  desired  this  is  best  obtained  by  the  use  of  the  neutral  bath 
continued  for  periods  ranging  from  thirty  to  sixty  and  even  ninety 
minutes.  The  aim  in  this  bath  is  to  avoid  all  the  stimulating  influ- 
ences that  take  place  with  reaction.  Care  should  be  exercised  not  to 
employ  friction  after  the  bath;  dry  the  patient  as  rapidly  and  as 
gently  as  possible.  Secure  dryness,  if  possible;  if  perspiration  takes 
place,  evaporation  causes  chilliness,  and  the  effect  of  the  bath  is 
defeated.  The  evil  effects  of  the  neutral  bath  are  chilliness,  exhaus- 
tion, headache,  nervousness  and  irritability.  I  cannot  speak  with  the 
enthusiasm  of  some  writers  upon  the  benefit  of  the  neutral  bath  for 
the  relief  of  insomnia.  It  has  given  some  good  results,  but  usually 
the  patient  has  been  one  who  possesses  very  strong  and  active  circu- 
lation. 

Among  sedative  procedures,  especially  for  the  relief  of  insomnia, 
may  be  recommended  the  cold  full  wet  pack  at  a  temperature  ranging 
from  75°  to  65°  F.,  it  having  proven,  in  my  hands,  the  most  satisfac- 
tory method. 

There  is  a  popular  superstition  that  organic  heart  disease  abso- 
lutely precludes  the  utilization  of  hydrotherapy.  This  is  very  far 
from  the  truth,  as  I  have  demonstrated  too  frequently  in  my  practice. 
Care  must  be  exercised,  however,  to  most  cautiously  and  carefully 
train  the  patient  to  stand  hydriatic  procedures,  very  mild  in  their 
nature  at  first,  but  gradually  changed  and  adapted  to  the  improvement 
that  takes  place.  It  is  my  rule  to  never  give  these  cases  very  low 
temperatures  nor  very  great  pressure  stimulation,  and  to  sedulously 
avoid  the  application  of  even  moderately  cold  percutient  measures  to 
the  chest  and  abdomen.  As  will  be  seen,  by  means  of  the  Schott 
method  of  baths  and  exercise,  organic  heart  disease  may  be  cured. 
In   functionally   irritable  and   weak  hearts   it  is  my  policy  to   follow 


RULES,  REGULATIONS  AXD  SUGGESTIONS.         105 

practically  the  same  method  of  training,  but  the  time  required  to  tone 
and  strengthen  cardiac  activity  is  naturally  very  much  shorter  than 
in  cases  of  organic  trouble. 

Speaking  in  general  terms,  chronic  diseases  of  the  skin  present 
certain  obstacles  to  treatment  by  means  of  water.  If  suppurating  boils, 
pimples  or  acute  eczema  are  present,  it  has  been  my  experience  that 
heating  procedures,  followed  by  neutral  or  tepid  applications,  give  the 
best  results.  Where  these  conditions  are  localized  or  circumscribed,  we 
should  proceed  with  the  treatment  as  though  they  did  not  exist.  Where 
it  is  important  to  prevent  the  water  reaching  the  circumscribed  con- 
dition, the  covering  of  the  parts  with  oil  silk  and  a  bandage  permits 
us  to  utilize  all  the  advantages  of  hydrotherapy  without  injury  to  the 
localized  eruption.  Acute  eruptions  of  the  uric-acid  or  auto-toxic 
type  are  benefited  by  hydrotherapeutic  applications.  Localized  irri- 
tations, pimples,  small  boils,  etc.,  frequently  appear  under  compresses ; 
this  can  be  prevented  by  keeping  the  compress  clean ;  nothing  equals 
simple  boiling. 

It  should  be  the  aim  of  the  hydriatist  while  prescribing  for  his 
patients  to  inculcate  proper  hygienic  laws,  and  at  the  same  time  to 
insist  upon  the  copious  or  free  drinking  of  plain  water  where  indi- 
cated. In  like  manner  it  is  needless  to  state  that  it  is  an  excellent 
time  and  hour  for  the  cessation  of  stimulants,  narcotics  and  their 
like. 

In  conclusion,  bear  in  mind  the  fact  that  Baron  Liebig,  fifty  years 
ago,  observed  that  "cold  air,  cold  water  and  exercise,  habitually  em- 
ployed, are  the  most  powerful  of  all  means  of  stimulating  tissue  ac- 
tivity." For  the  sake  of  condensation  and  ready  reference  the  fol- 
lowing table  is  appended : 

Bath.  Temperature,  Average  Tern-  Duration  of  Bath. 

Degrees  F.  perature. 

1.  Sponge  bath   50-70  60 Xo  fixed  time. 

2.  Cold  compress   34-50  40 Until  warmed. 

3.  Cooling  compress    60-70  60 Until  warmed. 

4.  Stimulating  compress    ...  50-70  60 Until  dry. 

5.  Hot   compress    110-130 120 Until  cooled. 

6.  Dripping    sheet 50-70  60 3  to  5  minutes. 

7.  Hot    fomentation 120-160.. 140 Xo  fixed  time. 

8.  Dry   full  pack Warm — Until  sweating. 

9.  Hot    wet   pack 120-130 125 y2  to  1  hour. 

10.  Cold  wet  pack 40-70  60 ^  to  1  hour. 

11.  Affusion     50-70  60 y2  to  1  minute. 

12.  Hot   foot  bath 105-120 110 5  to  30  minutes. 

13.  Cold    foot   bath 50-60  55 1   to  5  minutes. 

14.  Hot  sitz  bath 105-120 110 5  to  20  minutes. 

15.  Cold  sitz  bath 50-80  60 5  to  15  minutes. 

16.  Half  bath    50-80  65 2  to  5  minutes. 

17.  Cold  plunge 50-70  60 Instantaneous. 

18.  Hot    full    bath 100-115   104 2  to  10  minutes. 


106  PRACTICAL  HYDROTHERAPY. 

Bath-  Temperature,  Average  Tem-  Duration  of  Bath. 

Degrees  F.  perature. 

19.  Cold  full  bath 50-70  60 3  to   10  minutes. 

20.  Warm    full  bath 96-100 98 5  to  30  minutes. 

21.  Neutral   full  bath 94-96  95 20  to  60  minutes. 

22.  Brand    bath     60-70  65 10   to   15  minutes. 

23.  Hot   rain   bath 104-120  105 y2  to  1  minute. 

24.  Cold    rain   bath 50-70  60 5  to  20  seconds. 

25.  Hot    fan   douche 104-120 115 y2  to  1  minute. 

26.  Cold    fan    douche 50-70  60 10  to  20  seconds. 

27.  Hot  jet  douche 104-120 115 ]/2  to  1  minute. 

28.  Cold  jet   douche 50-70  60 10  to  20  seconds. 

29.  Hot   air   bath 110-180 160 5  to  20  minutes. 

30.  Body      superheated      dry 

hot  air  treatment 200-400 275 20  to  60  minutes. 

31.  Local  hot  air  bath 200-400 300 20  to  60  minutes. 

32.  Turkish  bath    150-200 180 10  to  20  minutes. 

33.  Russian   bath    110-130 120 10  to  15  minutes. 


CHAPTER  VIII. 

EQUIPMENT  OF  HYDROTHERAPEUTIC  INSTITUTIONS 
AND  SANATORIA. 

The  acme  of  hydrotherapeutic  accuracy,  the  best  and  most  per- 
manent results  in  chronic  diseases,  are  obtained  from  treatment  in 
institutions  and  sanatoria,  where  every  facility  is  at  hand  for  the 
refinement  of  technique.  I  have  obtained  results  with  a  few  sheets, 
pails  of  water  and  mediocre  intelligence  in  a  way  that  bespeaks  highly 
the  effects  of  water,  even  under  most  disadvantageous  conditions, 
when  used  in  acute  diseases  and  acute  manifestations  of  chronic 
troubles.  The  most  efficient  method  is  the  douche,  in  its  various  forms 
and  modifications,  because  of  its  powerful  thermic  and  percutient 
effects.  This  procedure  is  preferred  in  sanatoria  and  institutions  more 
than  any  other  method,  because  of  its  efficiency  and  the  shorter  time 
required  for  treatment.  The  general  practitioner  of  medicine  should 
not,  however,  be  deterred  from  using  hydriatic  procedures  in  acute 
febrile  and  other  manifestations  of  disease,  for  in  this  field  some  most 
startling  and  remarkable  results  are  obtained.  It  is  the  chronic  cases, 
those  who  are  sick  all  over,  whose  nutrition  is  bad,  who  need  the  gen- 
eral control  that  sanatoria  exercise,  that  the  practitioner  should  send 
away,  for  in  these  cases  it  is  necessary  that  the  patient  should  give 
himself   up   entirely   to   health-getting  in   order  that   he   may   secure 

good  results. 

Hydrotherapeutic  apparatus  is,  of  necessity,  bulky  and  expensive, 
and  its  erection  and  use  entail  a  cost  by  no  means  inconsiderable. 
The  arrangement  and  plan  of  such  an  institution  will  depend  largely 
upon  the  character  of  the  building  to  be  used  for  the  purpose.  The 
best  place  to  locate  the  rooms  is  in  ,the  basement ;  in  case  of  a  leak 
no  injury  would  result  to  contents  located  upon  lower  floors.  For 
the  sake  of  clearness,  two  drawings  are  herewith  appended ;  one  where 
a  large  oblong,  the  other  where  a  narrow  and  long  space  is  to  be  used. 
This  latter  arrangement  is  particularly  applicable  to  large  cities,  where 
the  houses  are  more  or  less  narrow  and  the  buildings  of  some  length. 

Before  arranging  his  institution  the  hydriatist  should  satisfy  him- 
self on  several  points  in  order  to  insure  the  successful  use  of  the 
apparatus  he  proposes  to  install.  An  abundant  supply  of  water  is 
necessary.  It  goes  without  saying  that  the  water  to  be  preferred  should 
be  soft  and  contain  as  little  mineral  as  possible.  Clear  water,  from 
esthetic  and  other  standpoints,  should  be  used,  although  this  cannot 
(.107) 


108  PRACTICAL  HYDROTHERAPY. 

always  be  obtained.  Mineral  waters  offer  absolutely  no  advantage 
whatsoever  in  the  practical  applications  of  hydrotherapy.  The  next 
essential  is  sufficient  volume  and  pressure  within  the  building.  With- 
out sufficient  pressure  the  various  forms  of  the  douche  will  fail  of 
their  effect  and  disappointment  result.  I  am  constrained  to  believe 
that  thirty — better  still,  forty — pounds  should  be  the  minimum.  In 
my  sanatorium  I  have  a  pressure  of  100  to  125  pounds,  and  at  times 
need  this  full  pressure.  In  order  to  obtain  sufficient  volume  and 
pressure,  the  main  supply  pipe  should,  in  my  opinion,  be  of  a  mini- 
mum diameter  of  four  inches  from  main  to  boiler  or  heating  appa- 
ratus ;  from  this  point  to  the  douche  apparatus  the  pipe  should  be  of 
a  diameter  not  less  than  two  inches,  and  the  douche  apparatus  pipes 
of  not  less  than  one  inch  in  diameter.  These  dimensions  are,  as  a 
rule,  difficult  to  obtain  from  water  companies  unless  intelligent  ex- 
planation is  made  of  the  essential  need  of  such  a  supply  for  treat- 
ment. Attention  should  be  given  to  the  question  of  ventilation  and 
heating.  Where  the  institution  is  located  in  the  basement,  ample 
windows  with  areas  permit  of  a  free  circulation  of  air  in  summer 
and  a  proper  ventilation  in  winter.  This  will  also  give  light,  al- 
though in  the  majority  of  instances  light  will,  even  in  the  day  time, 
be  obtained  by  artificial  means.  Care  must  be  exercised  to  avoid 
draughts,  and  to  this  end  those  rooms  in  which  the  temperature  is 
raised  should  be  provided  with  spring  doors  completely  closing  the 
openings.  1  am  of  the  opinion  that  the  douche-room  and  other  treat- 
ment-rooms should  have  a  temperature  of  from  75°  to  80°  F. 

One  of  the  esesntial  necessities  of  such  an  institution  is  an  unlim- 
ited supply  of  hot  water  during  all  the  months  of  the  year,  and  of 
cold  water  during  the  summer  months,  to  secure  temperatures  be- 
tween 50°  and  60°  F.  In  summer  time  water  from  a  deep  well  is 
of  a  sufficiently  cold  temperature  for  all  practical  purposes. 

This  brings  us  to  practical  consideration  of  the  floor  plan  of  such 
an  institution.  By  referring  to  the  diagram  the  writer  believes  the 
reader  will  find  there  incorporated  certain  features  that  are  of  de- 
cided advantage.  Note  should  be  taken  of  the  fact  that  the  floor  plan 
calls  for  two  separate  halls,  an  outer  and  an  inner  one.  It  is  obvious 
from  this  plan  that  the  servants  whose  duty  it  is  to  attend  to  the 
boiler  for  heating  the  water  can  enter  the  boiler  room  without  coming 
in  contact  with  those  who  are  taking  treatment.  The  various  treat- 
ment-rooms open  upon  the  inner  hall,  and  are  provided  with  doors 
that  completely  close  the  opening.  I  deem  it  of  importance  that  the 
cooling-  or  rest-room  should  be  at  the  extreme  end  of  the  floor  plan. 
This  room  should  be  moderately  lighted,  and  furnished  with  a  number 
of  cots,  or,  better,  couches,  upon  which  patients  may  recline.  Ex- 
perience has  taught  me  that  a  leather  couch,  properly  protected,  is 
the  best  for  this  purpose.     Adjoining  the  rest-room  is  the  dressing- 


ja. 


DOUCHES.  ENEMRS 
PRCKS 


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DOUCHE    ROOH 


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Plate  40 — Author's   Plan. 


A'li  COLD 
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l»   W  STEAM 

V////A  //.■■S//V////;////////V<'./'  ^///\\\  V/////A 
A 


Plate  40a— Diagram  of  Hydriatic  Room  (Mott). 


EQUIPMENT  OF  SANATORIA.  109 

room.  This  room  should,  in  my  opinion  be  painted  a  white  color, 
and  the  individual  dressing-rooms  or  stalls  furnished  with  perma- 
nent latticed  swinging  doors.  The  lower  edge  of  the  partitions  is 
about  nine  inches  from  the  floor,  and  rest  upon  nickel-plated  brass 
holders.  Each  room  is  furnished  with  from  eight  to  ten  porcelain 
hooks  upon  which  clothing  may  be  hung;  also  a  chair  for  the  pa- 
tients comfort.  It  is  hardly  necessary  to  state  that  the  reason  for 
the  raising  of  the  partition  nine  inches  from  the  floor  and  the  painting 
of  the  room  a  white  color  is  to  give  more  and  better  light  in  each 
compartment.  Adjoining  the  dressing-room  is  the  general  treatment- 
room,  which  should  be  furnished  in  marble,  and  in  which  there  should 
be  hot  air,  superheated  hot  air,  vapor  and  incandescent  electric  light 
baths.  The  author's  experience  has  been  so  favorable  with  the  incan- 
descent light  bath  that  he  has  almost  entirely  dispensed  with  the  use 
of  the  ordinary  hot-air  cabinet  in  this  room.  We  would  also  have  an 
incandescent  electric  light  cabinet,  a  special  arc  cabinet  bath  and  a 
body  and  joint  apparatus  for  the  application  of  superheated  hot  air. 
For  the  construction  and  arrangement  of  these  cabinets  the  reader  is 
referred  to  the  previous  chapter,  in  which  they  have  been  fully  dealt 
with.  It  will  be  noticed  that  from  this  room  a  door  opens  into  the 
"douche-room."  This  room  must  be  especially  constructed.  In  my 
sanatorium  there  are  brick  walls  on  each  side  laid  in  cement  and  cov- 
ered with  white  porcelain  tile  closely  and  carefully  laid  on.  The 
floor  is  laid  in  rough  concrete  and  abruptly  drained  to  the  center. 
The  room  is  twelve  feet  broad  by  twenty  feet  long  in  the  clear.  Along 
one  wall  is  to  be  found  a  foot  and  two  sitz  bath-tubs,  mounted  on 
marble  platforms.  These  tubs  are  so  arranged  that  the  water  from  them 
drains  upon  a  concrete  floor,  and  not  over  the  marble  base.  Adjoin- 
ing these  is  a  large  porcelain  bath-tub,  seven  feet  long,  placed  upon 
the  concrete  floor.  On  the  rear  wall  a  shower,  triangle  and  circular 
rain-bath  are  located.  The  room  is  equipped  with  the  author's  wall 
apparatus  and  Baruch's  douche  table.  This  wall  apparatus  and  table 
are  connected  with  the  circular  rain,  triangle,  fan,  jet  and  other 
douches.  It  is  impractical  to  operate  the  foot,  sitz  and  full  bath  from 
the  douche  table,  so  the  author  has  discontinued  this  method  and 
supplied  each  of  these  with  a  separate  hot  and  cold  water  supply, 
using  one-inch  brass  nickel-plated  piping  and  large  one-inch  faucets 
for  the  purpose.  As  this  apparatus  and  the  method  of  its  employment 
will  be  fully  described  in  a  later  chapter,  no  comment  will  be  here 
made.  The  rear  room  should  be  supplied  with  several  tables  or 
couches  for  packs,  fomentations,  compresses  and  enemas.  At  the  end 
of  the  hall  a  toilet-room  is  provided. 

All  of  the  rooms  are  furnished  with  concrete  floors.  In  the  cool- 
ing or  rest-room  a  rug  should  be  spread  between  the  couches.  The 
writer   has,    after   numerous    trials,    found   that   the   ordinary   rubber 


110  PRACTICAL  HYDROTHERAPY. 

carpet  is  by  far  the  most  satisfactory  covering  for  the  floor.  It  does 
not  become  cold  in  winter  nor  hot  in  summer,  and  with  the  moisture 
present  rarely,  if  ever,  rots.  The  concrete  floor  of  all  the  rooms,  ex- 
cept the  douche-room,  should  be  of  the  smoothest  kind.  The  douche- 
room  is  furnished  with  a  slatted  floor  so  arranged  as  to  be  perfectly 
level.  This  requires  the  sleeper  upon  which  the  slats  rest  to  be 
beveled  so  as  to  fit  the  sloping  floor  of  this  room.  The  slatted  floor 
should  be  constructed  in  five  or  six  sections,  so  arranged  as  to  enable 
them  to  be  easily  lifted  for  the  purpose  of  cleansing  the  floor  be- 
neath. They  should  be  made  to  fit  snugly  around  the  douche  table, 
the  marble  base  of  the  foot  and  full  bath-tub,  triangle  and  circular 
rain  bath.  The  timber  used  must  be  the  very  best  of  kiln-dried  cedar, 
put  together  with  brass  screws,  free  from  all  knots,  and  the  edges  of 
the  slats  rounded  with  a  plane.  The  entrance  from  the  general  treat- 
ment-room to  the  douche-room  should  either  be  on  a  level  with  the 
top  of  the  slatted  floor  or  furnished  with  a  slanting  entrance  to  pre- 
vent patients  stumping  their  toes.  The  entire  place  must  be  lighted  by 
overhead  electric  lights,  manipulated  by  easily  accessible  switches. 

The  rapid  resume  of  a  patient's  treatment  would  be  the  entrance 
from  the  outer  hall  into  the  inner  hall  and  dressing-room,  where, 
after  disrobing,  with  a  sheet  thrown  around  him,  he  enters,  at  the  re- 
quest of  the  attendant,  the  general  treatment-room,  receives  a  pre- 
liminary aplication  of  the  incandescent,  arc  or  hot-air  bath.  Following 
this  he  enters  the  douche-room,  and,  after  receiving  the  hydriatic 
measures  prescribed,  and  reacting  properly,  he  is  then  dried  and  re- 
tires along  the  inner  hall  to  the  cooling  or  rest-room,  from  which  he 
shortly  emerges,  resumes  his  street  attire,  and  departs. 

It  is  necessary  to  have  an  ample  supply  of  towels,  preferably  of 
the  rough  Turkish  variety ;  linen  and  Turkish  sheets,  Turkish  bath 
robes,  stockinettes  and  glovelets  for  use  in  the  superheated  dry  hot-air 
apparatus ;  several  rough  linen  sheets,  a  dozen  or  two  of  fine  linen 
sheets,  some  large  soft  woolen  blankets,  a  pair  of  double  blankets  for 
the  wet  sheet  pack,  fomentation  cloths  made  of  thin  blanket,  cheese 
cloth  for  compresses,  ice  helmet,  hot-water  bottles,  etc.  The  treat- 
ment-rooms should  be  supplied  with  a  large  and  commodious  closet, 
with  tight  fitting  door  and  Yale  lock.  In  this  closet  all  the  linen, 
blankets,  and  various  articles  mentioned  above,  should  be  kept,  and 
if  the  door  fits  accurately  the  moisture  in  the  air  will  not  penetrate 
and  make  the  articles  damp  or  mildewed.  There  should  be  sufficient 
room  in  which  to  place  under  lock  and  key  bath-robes,  bath-caps, 
shoes,  slippers,  etc.,  belonging  to  individual  patients.  This  may  seem 
a  small  detail,  but  the  careful  enforcement  of  the  rule  of  keeping 
things  locked  up  will  prevent  many  petty  quarrels  between  patients, 
attendants  and  others,  to  say  nothing  of  preventing  stealing.  The 
douche-room  must  be  supplied  with  a  large  nickel-plated  brass  soap- 


hd 


H 

o 

— 


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o 


71 


rjf 

[                                 i 

.  -Ii,  i  _  J9 

Plate    43 — Bath    Room    Accessories ;    Pitcher ;    Salt   Jar ;    Thermometer ;    Fibre 
Bucket  ;  Bath  Room  Floor  Slats. 


EQUIPMENT  OF  SANATORIA.  Ill 

stand,  with  "Ivory"  soap  for  those  who  desire  to  use  same;  a  large 
two-gallon  pitcher,  preferably  of  granite  ware ;  large  pail  and  a  large 
jar  filled  with  salt  of  medium  coarseness.  It  should  be  borne  in  mind 
that  perfect  cleanliness  is  one  of  the  prerequisites  for  the  preserva- 
tion and  usefulness  of  all  apparatus  enumerated.  The  room  should 
be  cleaned  thoroughly  daily,  the  incandescent  globes  in  the  incandes- 
cent electric  light  bath  carefully  wiped  free  of  dust  and  specks,  the 
nickel-plated  trimmings  in  the  douche-room  rubbed,  and  such  other 
housewifely  cleanliness  maintained  as  common  sense  would  dictate. 

It  is  a  small  but  practical  point  to  be  borne  in  mind  that  the  nickel- 
plating  and  bright  appearance  of  all  piping  of  the  various  pieces  of 
apparatus  will  be  preserved  and  maintained  if  the  attendant  will  be 
sure  to  allow  very  hot  water  to  run  through  the  apparatus  just  before 
leaving  the  treatment-rooms. 

In  speaking  of  the  electric  light  bath,  it  was  stated  that  the 
attendant  must  never  throw  on  the  main  switch  while  the  smaller  or 
knife-blade  switches  governing  the  various  rows  of  lights  are  in  con- 
tact, as  the  fuse  will  be  blown.  This  can  be  prevented  by  having  the 
large  switch  next  the  ceiling  out  of  the  reach  of  the  attendant,  thus 
preventing  mischief  of  this  kind.  To  run  an  incandescent  electric 
light  bath  of  even  moderate  size  is  an  item  of  considerable  expense, 
and  attendants  should  be  instructed  to  never  turn  on  the  lights  until 
the  patient  is  in  the  cabinet,  and  to  always  turn  off  the  lights  before 
the  patient  leaves  the  cabinet.  This  is  also  true  of  the  arc  light,  and 
in  less  measure  of  the  superheated  dry  hot-air  apparatus. 

A  large  basket  should  be  furnished  in  the  dressing-rooms  in  which 
the  patient  may  toss  the  wet  towels  that  have  been  used.  Most 
institutions  of  this  kind  and  sanatoria  find  many  of  their  towels  ruined 
by  that  frailty  of  human  nature  which  leads  patients  to  polish  their 
boots  and  shoes  with  other  people's  towels.  For  this  and  for  other 
good  and  excellent  sanitary  reasons  all  towels  must  be  thoroughly 
washed,  boiled  or  sterilized  and  then  dried.  In  my  sanatorium,  for 
the  purpose  of  drying,  an  artificially  heated  drier  is  used.  Small  soft 
towels  are  furnished  for  facial  use,  although  in  many  instances  the 
rougher  or  crash  towel  is  to  be  preferred.  Each  dressing-room,  or, 
what  is  more  preferable,  each  patient,  should  be  furnished  with,  or 
furnish  himself,  a  soft  linen  sheet  in  which  to  enwrap  the  body 
during  his  passage  from  the  dressing-rooms  to  treatment  and  vice 
versa.  By  wrapping  the  patient  in  a  sheet  too  rapid  evaporation  is 
prevented,  and  he  is  not  chilled  by  passing  to  or  from  dressing-  and 
treatment-rooms.  By  just  such  little  details  and  precautions  colds 
and  discomforts  are  prevented  and  success  secured.  There  are  a 
number  of  cases  whose  reactionary  power  is  so  great  that  they  might 
dispense  with  the  use  of  a  sheet,  but  from  esthetic  as  well  as  hygienic 
reasons  it  is  required.      Those  persons  who  chill  very  easily  should 


112  PRACTICAL  HYDROTHERAPY. 

wear  sandals,  shoes  or  slippers  to  and  from  the  bath  treatment-rooms. 
There  is  no  question  in  these  cases  but  what  the  difference  in  tempera- 
ture at  the  floor  and  higher  in  the  room  is  sufficient  to  produce  this 
condition.  The  author  would  suggest  the  heelless  sandal  so  much  in 
use  in  German  and  Austrian  bathing  establishments. 

Upon  leaving  the  treatment-rooms  at  the  end  of  the  day  the 
attendant  gathers  up  and  removes  all  wet  towels  and  sheets ;  opens  the 
windows,  especially  in  summer,  to  secure  ample  ventilation,  and  leaves 
everything  in  tidy  condition.  If  this  becomes  a  fixed  habit  the  musty 
odor  common  in  some  hydriatic  institutions  will  be  obviated. 

It  is  necessary  to  have  a  scale  in  all  hydriatic  institutions,  the 
pivot  and  other  portions  of  which  should  be  of  brass  so  that  it  will 
not  rust  in  the  humid  atmosphere.  As  I  have  stated  before,  it  is 
necessary  to  watch  the  nutritional  changes  taking  place  in  patients,  by 
the  scale,  for  any  marked  change  in  weight  should  at  once  challenge 
the  attention  of  the  hydriatic  specialist  and  lead  him  to  modify  his 
treatment  according  to  the  aim  and  purpose  to  be  attained. 

There  is  nothing  so  valuable  to  a  physician  as  an  intelligent,  careful 
and  sympathetic  attendant  in  the  bath-room,  one  who  thoroughly 
appreciates  and  understands  the  prescription,  and  who  can  intelli- 
gently vary  minor  details  to  the  comfort  and  satisfaction  of  the 
patients.  Nurses  and  attendants  soon  learn  to  carefully  note  the 
condition  of  the  patient  entering  the  treatment-room.  The  ability  to 
tactfully  induce  patients  to  take  a  bath  who  are  unaccustomed  to  cold 
water  is  attained  only  by  considerable  experience.  It  is  my  rule  to 
invariably  start  with  graduated  applications  both  with  regard  to 
thermic  and  mechanical  impressions,  and  in  this  way  much  distress 
is  prevented.  By  gradually  accustoming  the  skin  surface  to  reaction 
and  to  the  mechanical  impressions  produced  by  the  more  vigorous 
applications  to  the  external  surface,  the  most  sensitive  and  delicate 
can  be  brought  to  bear  very  low  temperatures  and  strong  mechanical 
impressions.  Here  again  I  repeat  that  the  essential  necessity  of 
success  not  only  depends  upon  the  careful  and  thorough  work  of  the 
attendant,  but  upon  his  securing  prompt  satisfactory  reaction,  together 
with  all  the  exhilaration  and  stimulation  that  follow.  Nurses  who 
have  had  long  training  in  hydriatic  work  can  promptly  tell,  by  the 
touch  of  the  hand,  something  of  the  reactive  capacity  of  patients. 
The  attendant  should  insist,  where  the  patient  is  strong  enough,  that 
he  rub  himself,  and  thus  aid  in  bringing  about  reaction. 

Be  careful  to  see  that  the  head  is  kept  cool  during  the  application 
of  any  heating  procedure,  and  even  during  the  bath  itself.  Wet  the 
hair  thoroughly  and  keep  a  cold  towel  or  turban  upon  the  head  during 
the  application.  Some  men,  and  nearly  all  women,  refuse  to  have  the 
hair  made  thoroughly  wet,  owing  to  the  difficulty  and  fatigue  of  drying 
the  scalp  after  a  thorough  wetting  of  the  hair.     This  can  be  obviated 


o 


Plate  44 — Ice  Cap  or  Helmet ;  Steam  Kettle. 


EQUIPMENT  OF  SANATORIA.  113 

by  the  use  of  a  cap  made  of  rubber  or  oil  silk,  ice  helmet,  or  by  bathing 
the  face  in  cold  water  just  before  and  keeping  a  cold  towel  around  the 
neck  during  the  hot  application.  The  author  is  very  much  opposed 
to  a  hubbub  in  the  bath-rooms.  Hilarity,  singing,  whistling,  noisy 
talking,  loud  laughter  and  joking  are  decidedly  out  of  place.  Quiet 
should  be  maintained  and  patients  encouraged  not  to  converse  with 
each  other  or  with  the  attendant  while  taking  treatment.  It  has  been 
my  observation  that  in  this  way  better  attention  is  secured  and  more 
care  taken  with  the  patient. 


CHAPTER  IX. 
THE  TECHNIQUE  OF  HYDROTHERAPY. 

As  it  is  in  all  branches  of  the  healing  art,  hydrotherapy  possesses 
its  proper  technique.  As  a  surgical  operation  is  incomplete  or  a 
failure  unless  the  proper  method  is  pursued,  so  in  hydriatics  those 
results  that  can  and  should  be  obtained  are  lost  unless  care  and  atten- 
tion are  given  to  proper  detail.  Most  hydriatists  in  their  treatises 
upon  this  branch  are  prone  to  magnify  and  refine  each  process  until 
the  student  and  practitioner  are  lost  in  a  maze  of  minutiae,  become 
disheartened  and  give  up  the  study  of  a  valuable  measure,  possibly 
the  best  single  weapon  of  his  therapeutic  armamentarium.  My 
endeavor  has  been  to  simplify  as  much  as  possible,  to  group  together 
measures  that  have  similar  physiological  and  therapeutic  action,  or 
that  employ  similar  apparatus  and  technique,  thus  doing  away  with 
needless  burdens  upon  the  time  and  memory  of  the  active  man  in  the 
field.  The  time  that  has  to  be  consumed  by  the  busy  general  practi- 
tioner over  such  works  leads  them,  as  well  as  hydriatics,  to  be  laid 
aside  for  methods  more  easily  mastered. 

Having  learned  the  physiological  portion  of  hydrotherapy,  we  are 
prepared  to  understand  that  the  technique  may  be  grouped  under  six 
heads,  dependent  upon  the  methods  used  as  to  whether  we  desire 
to  obtain — 

A.  Distinctly  local  effects. 

B.  General  effects. 

C  Purely  thermic  effects. 

D.  Thermic  effects  supplemented  by  mechanical  action. 

E.  Employing  the  same  apparatus. 

F.  Having  the  same  physiological  action. 

In  the  actual  treatment  of  a  case  the  power  to  respond  to  these 
methods  must  be  carefully  studied,  or,  as  Winternitz  puts  it,  "the 
degree  of  stimulation"  estimated ;  in  fact,  here  as  elsewhere  the  per- 
sonal equation  and  therapeutic  need  cannot  be  lost  sight  of  for  a 
moment.  The  "measure  of  stimulation"  is  controlled  by  means  of 
jour  elements,  viz. : 

1.  Extent  of  application. 

2.  Temperature. 

3.  Duration. 

4.  Mechanical  effects. 

(114) 


THE  TECHNIQUE  OE  HYDROTHERAPY. 


115 


At  the  present  time  we  are  unable  to  classify  from  a  physiological 
point  of  view,  and  for  that  reason  the  author  offers  the  following 
"Clinical  Order,"  it  being  an  advance  from  the  simple  to  the  complex: 

Alternate  hot  and  cold  sponge  to  the  spine. 

Dripping  sheet. 

Fomentation. 

Compresses. 

Half  pack,  dry. 

Full  pack,  dry. 

Half  pack,  wet. 

Full  pack,  wet. 

Hot  foot  bath. 
Cold  foot  bath. 


Foot  bath 


Sitz  bath 
Half  bath. 


Full  bath 


Hot  sitz  bath. 
Cold  sitz  bath. 

Very  hot  full  bath. 

Hot  full  bath. 

Warm  full  bath. 

Cleansing  full  bath. 

Continuous  full  bath. 

Neutral  full  bath. 

Effervescent  full  or  Xauheim  bath. 

Cold  full  bath. 

Cold  plunge. 


Surf  bathing. 
Swimming  bath. 
Mineral  baths. 

Affusions. 


Douches 


Showers. 
Sprays. 
Jet  douches. 


The  Sponge  or  Towel  Bath;  Ablution. 

This  simple  and  satisfactory  method  is  universally  applicable,  and 
may  be  employed  in  the  humblest  of  surroundings.  It  may  be  used  as 
an  antipyretic  or  as  an  introduction  in  chronic  cases  to  the  more 
vigorous  measures.  The  sponge  is  usually  given  to  febrile  patients 
in  bed.  Two  basins,  containing  water  at  the  proper  temperature,  one 
of  50°  F.,  the  other  70°  to  60°  F. ;  a  slop  jar,  two  crash  rags  and 
several  crash  towels  without  fringe  is  the  simple  paraphernalia  re- 
quired. The  nurse,  having  arranged  the  basins,  jars,  rags  and  towels 
handy,  slips  off  the  night  dress  and  has  the  patient  recline  upon  the 
right   side    (edge)    of   the   bed    (in    right-handed   nurses)    facing  the 


116  PRACTICAL  HYDROTHERAPY. 

nurse.  The  rag  is  now  dipped  in  the  basin  of  water  at  50°  F.  and  the 
face  and  neck  sponged.  The  surplus  water  is  squeezed  into  the  slop- 
jar,  the  rag  re- wet  and  placed  upon  the  patient's  forehead.  The 
patient's  left  arm,  then  the  right,  the  left  and  then  the  right  leg,  are 
successively  exposed  and  sponged  with  the  crash  rag,  containing  all 
the  water  it  will  hold  short  of  dripping.  The  patient  then  turns  over, 
lying  on  the  belly,  and  the  back  is  sponged  from  occiput  to  coccyx  and 
over  the  hips ;  then  turns  upon  the  back,  and  the  chest  and  abdomen 
are  sponged.  If  longer  time  is  employed  allow  towel,  after  sponging, 
to  remain  on  back,  chest  and  abdomen  three  minutes  each.  As  we 
have  previously  said,  the  towel  or  compress  may  remain  on  the 
abdomen  for  an  hour  after  the  sponge.  Very  feeble  cases,  who 
are  febrile,  whose  circulation  and  innervation  are  bad,  who  are  easily 
exhausted  (asthenic),  should  have  each  member  dried  as  the  applica- 
tion is  made,  and  the  towel  or  compress  avoided.  After  the  bath 
they  receive  their  nourishment,  and  if  they  have  not  reacted  a  hot- 
water  bottle  must  be  put  to  their  feet.  If  strong  and  vigorous 
(sthenic),  do  not  dry  and  use  the  towel  or  compress.  Where  this 
measure  is  employed  systematically  during  the  course  of  typhoid, 
bathe,  feed  and  medicate  at  the  one  time  so  that  the  patient  and  nurse 
will  have  intervals  of  rest.  Cold  water  drinking  between  times  is  a 
useful  adjunct. 

It  is  a  good  plan  to  start  with  high  temperatures,  giving  the  first 
bath  at  75°  F.,  reducing  the  temperature  of  each  succeeding  sponge 
five  degrees  to  60°  or  50°  F.,  as  deemed  wise.  Always  use  cold  (50°) 
or  very  cold  water  to  bathe  the  face  and  neck ;  re-wet  this  compress  as 
soon  as  it  gets  warm.  The  water  in  the  rag  should  be  squeezed  out 
into  the  slop- jar  and  re-wet  from  the  basin  to  avoid  warming  the 
water. 

The  sponge  must  be  varied  to  meet  certain  indications.  If  the 
case  is  febrile,  vigorous,  with  good  innervation  and  considerable  anti- 
pyretic and  stimulating  effects  are  desired,  the  arms  and  legs  should 
be  left  zuet,  in  order  that  evaporation  may  enhance  the  anti-febrile 
action  of  cold  water.  When  the  back,  chest  and  abdomen  are 
reached  they  should  first  be  sponged,  then  wet  thoroughly  one  of  the 
crash  towels  and  place  upon  the  entire  back,  chest  and  abdomen,  or 
each  successively,  and  over  which  friction  is  to  be  applied.  It  may  be 
wet  and  re-wet  from  the  basin  without  removal.  Friction,  as  we  have 
seen,  overcomes  the  superficial  contraction,  dilates  the  blood-vessels, 
aad  by  reflex  action,  as  well  as  by  heat  abstraction,  acts  upon  the 
thermogenic  and  vasomotor  centers  in  the  medulla  and  cord,  limiting 
heat  formation  and  increasing  heat  elimination.  As  we  cannot  secure 
friction  from  a  sponge,  it  should  never  be  employed.  In  typhoid 
(mild  cases,  temperature  not  above  102.5°  F. )  this  method,  repeated, 
will  give  excellent   results,  and  may  be  employed   during  the  entire 


THE  TECHNIQUE  OF  HYDROTHERAPY.  117 

course  of  the  disease.     In  this  infectious  disease  the  towel  maj    be 

wet  and  re-wet  several  times  during  the  course  of  the  time  it  re- 
mains on  the  abdomen.  The  time  required  for  the  entire  sponge 
is  usually  thirty  to  forty  minutes — arms  four  minutes  each,  legs  four 
minutes  each,  back  and  chest  four  minutes  each,  abdomen  six  min- 
utes. .Always  keep  a  cold  compress  or  ice  cap  on  the  head  as  this  will 
prevent  a  rush  of  blood  to  the  head,  or  retrostasis,  besides  making 
the  patient  more  comfortable.  Be  sure  to  always  make  sufficient 
pressure  with  the  rag  to  create  friction.  When  completed,  slip  on  the 
night  dress,  and  in   febrile  cases  cover  lightly   (with  sheet). 

The  physiological  action  is  that  of  cold  applied  to  the  external  sur- 
face, together  with  the  supplemental  influence  of  friction.  The 
peripheral  circulation  becomes  larger  through  the  reflex  action  of 
the  friction,  thus  offering  a  larger  surface  of  blood  to  the  thermic 
action  of  the  cold.  Reflexly,  the  heart  is  slowed,  the  pulse  becomes 
fuller,  and  the  cooled  blood  current,  setting  inward,  reaches  and 
arouses  the  nerve  centers  to  throw  off  the  toxic  lethargy.  The  res- 
piration is  freer,  better  oxygenation  and  elimination  take  place  from 
this  and  all  other  excretory  organs.  The  nervous  system  is  toned, 
aroused  and  refreshed;  the  patient  is  stimulated,  and,  as  we  have 
before  noted,  temperature  reduced.  It  is  now  much  used  in  typhoid, 
although  the  valuable  effect  of  the  compress  with  friction  is  rarely 
employed. 

The  author  remembers  the  grateful  toning  and  refreshing  influ- 
ence of  the  cold  sponge  at  50°  when,  several  years  ago,  he  had  the 
one  and  only  febrile  attack  of  his  life.  The  intense  neural  and  sys- 
temic relief  given  more  than  compensates  for  the  temporary  discom- 
fort of  its  application. 

As  an  introductory,  in  chronic  diseases  and  ambulatory  cases,  to 
more  active  measures,  the  author  uses  it  as  follows :  A  heating  meas- 
ure is  first  employed — pack,  hot  air,  electric  light  bath — after  which 
the  patient  steps  into  a  foot-tub  of  very  hot  water,  and  is  rapidly 
sponged — face,  neck,  arms,  trunk,  legs.  There  should  be  considerable 
friction  used,  and  reaction  afterward  secured  by  means  of  good  rub- 
bing with  a  warm  crash  towel.  This  measure  I  have  found  of  signal 
benefit  as  a  home  remedy  in  cases  that  cannot  come  for  institutional 
treatment.  It  is  astounding  what  an  influence  this  simple  bath  will 
exert  upon  anemia  and  chlorosis,  in  neurasthenics,  the  pre-tubercu- 
lous  and  others.  These  cases  can  apply  the  treatment  themselves,  it 
being  generally  used  on  arising  in  the  morning,  owing  to  the  fact  that 
the  person  has  accumulated  heat  upon  the  surface  during  the  stay 
in  bed. 

Hot  sponging  may  be  employed  in  fevers,  but  is  now  rarely  used. 
The  sponge  should  be  very  brief  with  water  at  130°  to  140°.  It  is 
sometimes  useful  when  applied  to  the  spine  in  functional  nervous  dis- 


118  PRACTICAL  HYDROTHERAPY. 

eases,  neuralgia,  etc.,  but  the  author  prefers  the  alternate  sponge  for 
this  purpose.  Alkalies,  usually  soda,  may  be  added  and  used  in  urti- 
caria, pruritus,  etc.     Friction  is  not  needed. 

The  alternating  hot  and  cold  sponge  to  the  spine  is  a  useful  meas- 
ure that  will  give  relief  in  certain  conditions.  It  is  best  performed 
by  using  a  cloth  wrung  out  of  the  very  hottest  water  that  can  be 
borne  (140°  to  160°  F.),  applying  it  up  and  down  the  spine  for  ten 
to  thirty  seconds,  followed  by  a  sponge  or  rag  dipped  in  very  cold 
water  (40°  to  50°  F.),  or  a  block  of  ice  wrapped  in  a  soft  towel,  for 
three  to  ten  seconds.  These  alternations  should  be  kept  up  three  to 
five  minutes  or  longer,  if  agreeable  to  the  patient.  The  alternate 
sponging  of  the  spine  has.  in  my  hands,  been  chiefly  used  for  insomnia, 
although  it  aids  in  overcoming  the  unpleasant  spinal  symptoms  of 
neurasthenia.  Most  patients  state  that  it  has  a  decidedly  reviving 
effect  upon  the  system.  It  can  be  used  in  all  forms  of  irritation, 
whether  located  in  the  spine  or  not,  in  headaches,  intercostal  neu- 
ralgia and  general  nervousness.  It  has  a  decided  influence  upon  res- 
piration and  heart  action,  and  for  this  reason  is  of  value  in  those 
troubles  accompanied  by  the  sudden  failure  of  action  of  either  of 
these  organs.  For  the  temporary  amelioration  of  the  pain  and  dis- 
comfort at  the  nape  of  the  neck,  often  complained  of  by  women, 
it  will  be  found  a  resource  of  some  value.  In  bruises,  injuries  to 
joints,  sprains,  inflammations  of  muscles,  the  pains  of  trauma,  trau- 
matic arthritis,  etc.,  relief  from  suffering  and  restoration  of  function 
often  follow  its  use. 

The  Dripping  Sheet  or  Sheet-Bath. 

This  is  a  simple,  satisfactory  and  ingenious  method  of  applying 
water  to  the  surface  of  the  patient  who,  for  certain  reasons,  is  unable 
to  stand  other  measures,  is  bedridden  or  the  subject  of  acute  disease. 
In  applying  the  sheet-bath  the  paraphernalia  used  are  a  linen  sheet, 
preferably  coarse,  about  three  yeards  long  and  two  yards  wide ;  a 
pail  in  which  to  wet  the  sheet,  a  foot-tub  for  hot  water,  a  dry  sheet 
and  some  Turkish  towels.  The  nurse,  having  previously  gathered 
the  sheet  together  by  one  edge  of  the  long  measure,  places  same  in 
the  pail  of  water  at  the  temperature  indicated,  ranging  from  50°  to 
70°  F.,  and  partially  wrings  the  water  out.  The  patient,  having  had 
his  face  and  head,  or  in  women  the  neck,  cooled  and  protected  by  a 
cold  towel,  turban  or  ice-cap,  steps  into  the  foot-tub  containing  hot 
water  of  sufficient  depth  to  cover  well  the  ankles.  If  the  water  in 
the  foot-tub  is  sufficiently  hot,  much  of  the  disagreeable  sensation 
of  cold  will  be  obviated.  The  patient  now  removes  the  night  dress 
or  throws  off  the  dry  sheet  with  which  he  is  covered,  and  the  wet 
sheet  is  wrapped  around  the  body  in  the  following  manner:  Holding 
the  long  measure  of  the  sheet  in  the  right  hand,  the  nurse  seizes  the 


Plate  47 — Dripping  Sheet — Ready. 


Plate  48— Dripping   Sheet— First   Stage. 


Plate  49— Dripping  Sheet — Second  Stage. 


Plate  50 — Dripping  Sheet — Completed. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  119 

upper  left  hand  corner  with  his  left  hand,  and  steps  in  front  of  the 
patient.  The  patient  holds  up  both  arms  while  the  nurse  places  the 
upper  left  hand  corner  of  the  sheet  under  the  right  arm,  far  enough 
to  reach  the  back ;  the  patient  then  lowers  the  right  arm,  holding  the 
sheet  in  place ;  the  nurse  rapidly  passes  the  sheet  across  the  front  of 
the  body,  beneath  the  left  arm,  which  is  immediately  lowered  to  hold 
the  sheet  in  place.  The  sheet  is  then  carried  across  the  back,  brought 
up  over  the  right  arm  and  shoulder,  across  the  chest,  and  over  the 
left  arm  and  shoulder.  It  is  then  folded  and  tucked  into  the  upper 
edge  around  the  neck.  Where  the  nurse  is  quick  this  operation  does 
not  consume  more  than  five  to  ten  seconds,  and  when  promptly  per- 
formed does  away  writh  a  great  deal  of  the  discomfort  of  a  slowly 
applied  cold  body.  The  lower  ends  are  now  tucked  between  the  legs. 
The  sheet  being  in  position,  the  nurse  begins  to  rub  vigorously  with 
both  hands,  using  good  sweeping  strokes,  covering  the  whole  surface 
as  quickly  as  possible,  rubbing  simultaneously  first  the  chest  and  back, 
then  the  back  and  abdomen  and  then  the  extremities.  The  rubbing 
should  be  continued  from  one  to  three  minutes,  or  until  the  sheet  is 
thoroughly  warm.  It  should  be  borne  in  mind  that  the  object  aimed 
at  is  not  rubbing  the  patient  with  the  sheet,  but  the  application  of 
friction  over  the  sheet.  Rapidity  of  movement  in  placing  the  sheet 
in  position  and  the  quick  application  of  friction  are  essential,  for  the 
object  is  not  to  abstract  heat,  but  to  produce  tonic  reaction  and  a  de- 
cided cutaneous  hyperemia.  When  the  sheet  has  become  well  warmed 
it  is  quickly  dropped,  the  patient  covered  with  a  dry  sheet  and  rubbed 
thoroughly  dry  with  Turkish  towels,  after  which  the  bed.  If  reac- 
tion has  been  prompt,  no  other  application  is  necessary;  if  the  patient 
feels  chilly,  dry  friction  with  the  hand  will  complete  the  reaction.  It 
should  be  noted  that  the  patient  must  be  protected  from  chilling  upon 
removal  of  the  sheet. 

This  treatment  is  simple  and  flexible.  The  different  amounts  of 
water  it  contains,  variation  in  temperature,  the  amount  and  vigor  of 
the  rubbing,  or  the  addition  of  percussion  or  slapping,  will  enhance 
its  physiological  action.  The  temperature  of  the  water  generally  used 
ranges  from  70°  to  50°  F.,  but  the  aim  is  to  reach  the  colder  degree 
as  rapidly  as  possible.  It  is  the  author's  custom  in  weak  and  bed- 
ridden cases  to  commence  with  mild  temperatures  of  very  short  dura- 
tion, and  gradually  decrease  the  temperature  and  increase  the  dura- 
tion until  the  maximum  effects  are  obtained.  Patients  that  are 
strangers  to  the  hydrotherapeutic  reaction  will  complain  at  first,  but 
later  along  will  not  mind  even  a  temperature  of  60°  or  50°  F.  Wrhere 
the  patient  is  in  condition,  however,  to  stand  the  primary  shock,  it 
is  my  custom  to  commence  with  70°  to  65°  F.,  as  we  obtain  a  better 
reaction.  The  temperatures  of  the  sheet-bath  can  be  materially  low- 
ered where  a  preliminary  heating  process  has  been  used.     For  this 


120  PRACTICAL  HYDROTHERAPY. 

reason  it  is  best  applied  to  bedridden,  sensitive  or  debilitated  patients 
early  in  the  morning,  when  they  have  the  accumulated  heat  of  the 
night  upon  the  skin  surface. 

Physiological  Action  of  the  Dripping  Sheet. — The  dripping  sheet 
or  sheet-bath  is  a  thermic  and  mechanical  irritant,  causing  deep  gasp- 
ing respirations,  rigor  or  shivering,  but  this  shock  of  the  first  impact 
of  cold  upon  the  surface  gives  way  to  a  stimulating  and  refreshing 
action  upon  the  nervous  system.  There  is  a  general  sensation  of 
warmth  and  glow  in  the  skin.  The  peripheral  blood-vessels  at  first 
contract  and  drive  the  blood  from  the  cutaneous  surface,  but  with 
the  reaction  that  takes  place  under  friction  the  blood-vessels  dilate 
and  blood  comes  to  the  surface.  The  pulse  is  slowed,  heart  action 
becomes  more  full  and  energetic,  and  blood  pressure  is  raised.  By 
this  means  the  work  of  the  heart  is  diminished.  This  cutaneous  circu- 
latory reaction  is  pronounced  and  lasting,  and  accompanying  it  are 
all  the  phenomena  noticed  under  "reaction."  If  a  tonic  effect  is  aimed 
at,  reaction  must  be  prompt  and  vigorous;  if  antipyretic,  it  must  be 
slowly  obtained.  The  depth  of  the  respirations  are  increased,  more 
prolonged,  and  exchange  of  pulmonary  gases  favored.  Muscular  ac- 
tivity is  increased,  strength  engendered,  well-being  induced,  all  oxida- 
tive and  assimilative  functions  stimulated,  and,  secondarily,  appetite 
and  digestion  improve.  There  is  a  uniform  fall  of  the  rectal  tempera- 
ture, though  this  is  temporary;  the  axillary  readings  may  remain  the 
same  or  become  elevated.  The  excellent  results  obtained  from  the 
dripping  sheet  make  it  a  procedure  valuable  beyond  computation  to 
those  practicing  in  rural  districts.  It  is  to  be  regretted  that  the  gen- 
eral practitioner  is,  as  a  rule,  prejudiced  against  hydriatc  procedures, 
and  fears  the  bugbear  of  cold  water. 

Therapeutics  of  the  Dripping  Sheet. — The  sheet-bath  is  an  excel- 
lent measure  for  those  who  are  feeble,  bedridden,  or  undergoing  the 
rest  cure,  relieving,  as  it  does,  the  various  circulatory  disorders  asso- 
ciated with  these  conditions.  Owing  to  the  lack  of  exercise,  it  is 
necessary  to  have  some  measure  by  means  of  which  the  slow  reac- 
tions and  more  or  less  chronic  congestion  of  the  viscera  can  be  re- 
lieved. In  those  digestive  states  in  which  we  have  to  deal  with  dimin- 
ished secretion,  lack  of  muscular  capacity,  with  relaxed  or  prolapsed 
abdominal  viscera,  the  sheet-bath  offers  a  valuable  and  potent  rem- 
edy. The  author  has  found  it  of  especial  benefit  in  the  Weir  Mitchell 
rest  cure  treatment,  in  nervousness,  excitability,  insomnia,  neuras- 
thenia, etc.  As  an  adjunct  to  the  administration  of  iron  in  chlorosis 
and  anemia,  especially  in  that  form  that  is  prevalent  in  young  girls, 
accompanied  with  digestive  disorders,  the  dripping  sheet  has  proved 
itself  to  be  a  most  potent  factor  in  the  therapeutics  of  these  affections. 
In  the  management  of  diarrhea  and  dysentery  the  author  can  speak 
from  long  experience  of  the  value  of  this  measure,  used  in  conjunc- 


Plate  51 — The  Fomentation — Ready. 


K4  j. -' 


Plate  52 — The   Fomentation — Pouring  the   Boiling  Water. 


THE  TECHNIQUE  OE  HYDROTHERAPY.  121 

tion  with  the  sitz  bath  and  friction.     There  are  few  contraindications, 
the  principal  obstacles  being  skin  eruptions,  neuritis  and  neuralgia. 

The  Fomentation. 

This  application  is  usually  called  the  "hot  fomentation,"  but,  as 
fomentations  are  never  cold,  the  addition  of  the  adjective  is  super- 
fluous. The  fomentation  is  a  most  valuable  procedure.  It  is  applied 
preferably  by  means  of  a  piece  of  old  blanket  about  a  foot  and  a  half 
square,  which,  after  being  saturated  with  boiling  water,  must  be  thor- 
oughly wrung  out  by  means  of  a  wringer.  The  simplest  manner  of 
constructing  this  wringer  is  to  use  a  piece  of  clucking  of  sufficient 
size,  to  the  extremities  of  which  two  strong  sticks,  about  two  feet 
in  length,  have  been  secured  by  tapes,  a  hem  or  stitching,  so  that 
their  ends  project  sufficiently  on  each  side  that  the  nurse  may  com- 
fortably grasp  the  ends  without  coming  in  contact  with  the  ducking. 
Its  technique  is  as  follows :  The  patient  lies  upon  the  bed  or  couch,  and 
the  part  to  be  treated  is  exposed  and  enveloped  in  a  blanket  pack 
covering  a  considerably  larger  area  than  the  fomentation,  the  ends 
of  the  blanket  being  long  enough  to  go  well  over  one  another.  The 
nurse  heats  a  large  pot  of  water  to  the  boiling  point  and  then  pre- 
pares the  wringer,  after  which  the  skin  surface  is  thoroughly  anointed 
with  an  oleate — vaseline  or  cocoa  butter.  The  nurse  places  the  wringer 
over  a  bucket  or  deep  basin  (see  cut),  and  on  it  the  piece  of  blanket, 
a  Turkish  towel,  flannel  or  woolen  cloth,  or  any  other  material  (the 
blanket  is  best),  and  then  pours  over  the  piece  of  blanket  boiling  water 
until  it  is  thoroughly  saturated.  It  is  now  lifted  out  of  the  basin  by 
means  of  the  wringer,  allowed  to  drain  for  a  couple  of  seconds,  and 
the  sticks  twisted  in  opposite  directions  (see  cut)  so  that  every  pos- 
sible drop  of  water  is  squeezed  out.  This  is  an  important  element 
of  the  technique,  for  if  any  water  remains  we  are  liable  to  scald  the 
patient.  Little  fear  of  a  burn  need  be  entertained  if  the  part  has  been 
well  rubbed  zwth  the  oleate  and  all  the  hot  water  has  been  carefully 
squeezed  from  the  piece  of  blanket.  So  essential  is  this  that  it  should 
be  constantly  impressed  upon  nurses.  The  nurse  takes  the  twisted 
wringer  containing  the  hot  moist  piece  of  blanket,  lays  it  beside  the 
patient,  opens  the  blanket,  then  unwraps  the  wringer,  slides  out  the 
fomentation  upon  the  affected  part  and  removes  the  wringer.  It 
must  be  quickly  adjusted  to  the  part,  the  blanket  closed,  and  all  air 
excluded  by  drawing  the  blanket  pack  tightly  over  the  fomentation, 
and  especially  close  at  the  ends.  The  patient  will  likely  complain  of 
the  intense  heat,  and  squirm  some,  but  must  be  encouraged  to  bear 
it,  as  this  will  disappear  as  soon  as  the  tissues  relax.  If  the  heat  can- 
not be  endured,  the  nurse  may  "ease"  matters  a  little  by  lifting  the 
fomentation  from  the  surface  for  a  few  seconds,  without  greatly  loos- 
ening the  blanket  pack,  and  again  dropping  it  in  place  and  retightening 


122  PRACTICAL  HYDROTHERAPY. 

the  pack.  The  fomentation  may  remain  in  place  for  five  to  ten  min- 
utes, and  may  be  immediately  repeated,  or  again  as 'soon  as  the  phy- 
sician deems  wise.  If  it  is  immediately  repeated  the  parts  must  be 
kept  covered  by  the  blanket  pack,  and  the  process  gone  through  with 
as  little  loss  of  time  as  possible.  Two  pieces  of  blanket  will  be  found 
useful  on  such  an  occasion,  the  nurse  preparing  the  second  one  while 
the  other  is  in  place,  being  thus  enabled  to  make  the  exchange  with 
great  rapidity,  a  feature  much  to  be  desired.  The  beneficial  effect 
of  the  fomentation  can  be  decidedly  enhanced  by  terminating  the 
treatment  with  a  brief  cold  application  not  to  exceed  a  minute.  The 
part  is  then  dried,  rubbed  briefly  with  the  dry  hand  and  protected 
from  the  air. 

Physiological  Action  of  the  Fomentation. — The  immediate  effect 
produced  by  the  contact  of  this  very  hot  body  is  that  of  pain,  accom- 
panied by  a  blanching  of  the  tissue,  due  to  contraction  of  the  blood- 
vessel walls.  The  confined  heat,  acting  upon  the  sensory  nerve  termi- 
nations and  penetrating  the  tissue  by  conduction,  causes  almost  im- 
mediately a  dilatation  of  the  blood-vessels  of  the  skin  and  contiguous 
tissues,  through  paralysis  of  the  constrictors  and  relaxation  of  the 
contracted  muscular  tissue  in  the  blood-vessel  walls  themselves.  Pri- 
marily a  local  revulsive,  excitant  and  stimulant  of  functional  activity, 
it  becomes  secondarily  a  sedative,  relaxant  and  analgesant  of  no  mean 
power.  The  high  temperature  stimulates  local  leucocytosis,  is  anti- 
bacterial, relieving  inflammation.  Anatomically  related  areas  may  be 
influenced  by  its  use.  It  may  be  employed  as  a  derivative  to  relieve 
congestion,  pain  and  inflammation.  It  is  a  stimulant  of  tissue  metabo- 
lism, increasing  the  functional  activity  of  a  part  through  the  aug- 
mented circulation  and  nerve  action.  Where  long  continued,  the  part, 
upon  its  removal,  follows  the  law  of  heat,  becomes  atonic,  its  processes 
and  vitality  lowered.  This  may  be  obviated  by  a  very  brief  appli- 
cation of  cold.  The  best  results  are  obtained  when  the  fomentation 
causes  slight  pain  when  first  brought  in  contact  with  the  skin.  Its 
temperature  should  range  from  140°  to  160°  F. 

Therapeutics  of  the  Fomentation. — It  is  a  simple  method  that 
has  a  wide  field  of  application,  and  in  skilled  hands  its  action  is  often 
magical.  In  all  those  states,  acute  or  chronic,  which  are  attended  by 
congestion,  inflammation  and  pain,  we  find  the  fomentation  indicated. 
Where  we  wish  to  increase  tissue  change,  leucocytosis,  absorb  swell- 
ings and  exudates,  we  may  expect  most  satisfactory  results,  especially 
when  it  is  followed  by  the  cold,  cool  or  stimulating  compress.  In 
spasmodic  muscular  states,  tremor,  cramps,  colics  accompanied  by 
cramps ;  in  gastritis,  enteritis,  hepatitis,  cystitis,  peritonitis,  all  inflam- 
mations of  the  pelvic  viscera,  external  organs  of  generation ;  in  sup- 
pressed menstruation,  dysmenorrhea,  amenorrhea,  ovarian  neuralgia, 
whether  acute  or  chronic,  the  fomentation  is  indicated.     Where  pain 


Plate  53— The  Fomentation— Removing  Water  with  Wringer. 


wm> 


Plate  54 — The  Fomentation— Removing  Water  by  Using  a  Twisted  Towel. 


Plate  55 — The  Fomentation — in   Position. 


Plate  56 — The  Fomentation — Completed. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  123 

of  any  origin  is  presented — in  headache,  backache,  "head-pressure"  of 
neurasthenics,  spinal  irritation — it  gives  almost  immediate  relief.  After 
surgical  procedures  its  judicious  application  will  give  much  relief  and 
avoid  the  use  of  narcotics.  For  the  relief  of  pain  after  divulsion  of 
the  sphincter  ani  it  is  a  specific.  The  pain  of  strains,  sprains  and 
dislocations  is  relieved  by  the  relaxation  of  tissue  which  it  brings 
about.  In  facial  acne  it  relieves  the  inflammation  and  congestion, 
stimulates  the  glandular  structures  and  prevents  the  accumulation 
of  sebum.  The  fomentation  can  be  abused  by  too  frequent  use,  and 
must,  like  all  other  measures,  be  adapted  to  the  case  in  hand.  Care 
must  be  taken  to  avoid  "catching  cold"  after  its  use,  as  general  per- 
spiration is  usually  present.  In  paralytics,  in  some  forms  of  neuritis, 
and  in  all  forms  of  myelitis  or  lesions  accompanied  by  trophic  troubles, 
the  fomentation  is  to  be  avoided  or  carefully  used.  The  author  has 
been  unable  to  discover  any  advantage  from  the  addition  of  medicines 
to  the  water  of  the  fomentation ;  what  we  desire  is  moist  heat  at  high 
temperatures. 

Compresses. 

The  compress  is  one  of  the  simplest  of  hydriatic  procedures,  but  is 
in  many  instances  a  most  efficient  method  of  applying  water  to  the 
treatment  of  disease.  It  consists  of  a  number  of  folds  of  old  linen, 
cheese  cloth,  or  other  suitable  material  of  such  size,  shape  and  length 
as  to  conform  to  the  anatomical  lines  of  the  part  treated.  If  the  com- 
press is  to  be  greatly  prolonged,  a  rubber  bag  or  rubber  tubing,  through 
which  water  at  the  proper  temperature  is  continually  passed,  may 
be  applied  over  the  compress  to  maintain  the  desired  temperature. 
The  malleable  Leiter  coil,  a  well-known  tubular  arangement,  through 
which  water  of  any  desired  temperature  can  be  made  to  flow,  offers 
an  ideal  method  for  maintaining  the  temperature  of  any  compress, 
and  their  malleability  enables  them  to  be  adapted  to  any  and  all  ana- 
tomical irregularities.  Where  neither  rubber  tubing  nor  the  coil  is  used, 
the  compress  must  be  frequently  changed — in  fact,  renewed  as  soon  as 
they  have  lost  an  undesired  degree  of  their  original  temperature. 

It  is  important  to  know  that  if  the  cold  compress  is  not  renewed 
with  sufficient  frequency  it  will  act  less  as  a  cooling  and  rather  as  a 
stimulating  agent,  an  effect  opposite  to  that  of  a  true  cooling  compress. 
The  compress  of  linen  or  cheese  cloth  is  wrung  out  of  water  at  the 
proper  temperature  and  moulded  to  the  part.  It  should  be  fairly 
wet,  but  not  dripping.  In  the  stimulating  and  hot  compress  the 
linen  cloth  is  surrounded  by  several  layers  of  flannel,  or  linen,  or 
any  impervious  material  of  the  same  shape,  but  somewhat  larger  in 
every  direction.  The  author  prefers  flannel,  as  it  best  prevents  evap- 
oration or  heat  loss.  This  compress  is  a  localized  wet  pack.  Com- 
presses are  classified  by  temperature : 


124  PRACTICAL  HYDROTHERAPY. 

1.  Cold  compresses  (cold,  50°  F.  and  below;  cooling,  55°  to 
70°  R). 

2.  Stimulating  compress  (50°  to  70°  F.). 

3.  Hot  compress  (110°  to  130°  F.). 

The  cold  compress  is  used  principally  for  its  antithermic  and  anti- 
phlogistic effect,  tending  to  subdue  inflammatory  conditions  by  direct 
heat  abstraction,  by  inhibiting  chemical  and  bacterial  processes.  This 
action  can  be  enhanced  by  wringing  out  less  water.  In  climates  or 
under  circumstances  where  cold  water  or  ice  cannot  be  obtained,  we 
may  have  recourse  to  chemical  means.  Of  this,  Kellogg1  says:  "  A 
very  satisfactory  substitute  may  be  found  in  ammonium  nitrate.  This 
chemical  substance  has  the  property  of  absorbing  an  enormous  amount 
of  heat  in  passing  from  the  solid  to  the  liquid  state.  By  adding  to  a 
quart  of  water  eight  ounces  of  nitrate  of  ammonium,  a  temperature 
of  41°  F.  was  secured,  the  initial  temperature  of  water  being  70°, 
and  the  temperature  of  the  room  in  which  the  experiment  was  made 
being  70°  F."  The  stimulating  compress  differs  from  the  cold  com- 
press in  that  reaction  is  aimed  at  in  order  to  secure  a  stimulation  of 
the  metabolic  and  vital  processes  locally.  This  compress  should  be 
allowed  to  remain  on  the  patient  until  it  is  nearly  dry.  The  hot 
compress  is  a  means  of  applying  heat  locally,  and  for  this  reason  an 
effort  should  be  made  to  retain  the  heat  as  long  as  possible.  It 
resembles  the  fomentation,  but  is  not  as  revulsive-  or  intense  in  its 
action.  It  increases  the  blood  supply  of  the  part,  stimulates  tissue 
change,  causes  local  break-down  and  pus  formation  by  enhancing 
local  nutritive  processes.  It  is  a  cleanly  substitute  for  the  "old- 
fashioned  poultice."  The  action  of  each  may  be  intensified  by  brief 
interruptions  and  alternations  of  temperatures ;  thus  a  cold  compress 
will  be  more  effective  if  at  proper  times  a  brief  hot  application  is  made, 
and  vice  versa.  When  once  the  physiological  action  of  the  cold, 
cooling,  stimulating  and  hot  compress  is  understood  it  becomes  un- 
necessary to  study  these  effects  as  applied  to  each  subdivision,  for  a 
compress,  whether  it  be  to  the  head,  foot,  leg,  trunk,  chest  or  throat, 
is  a  compress,  and  may  be  cold,  cooling,  stimulating  or  hot,  may  be 
alternated,  hot  or  cold,  without  the  necessity  of  considering  separate 
physiological  action. 

Physiological  Action  of  tlie  Cold  and  Cooling  Compress. — The 
first  effect  of  the  cold  and  cooling  compress  when  applied  to  the 
surface  of  the  skin  is  contraction  of  the  superficial  tissues  and  blood- 
vessels, thereby  restricting  the  amount  of  blood  in  the  part  to  which 
the  compress  is  applied,  at  the  same  time  causing  an  increased  activity 
in  blood-vessels  reflexly  related  to  this  surface.  As  the  aim  is  to 
avoid  reaction,  it  becomes  necessary  to  maintain  a  constant  tempera- 
ture, which  can  be  attained  by  frequently  renewing  the  compress,  or, 

1   Kellogg,   J.    H. :     "Rational   Hydrotherapy,"   p.    773. 


W   v* 


^L 


I' 


a  i 


Plate   57 — Stimulating   Compress — Compress   in    Position. 


Plate  58 — Stimulating  Compress — Completed. 


jm* 


•■*■ 


Plate  59— Coil  Cap  to  Head. 


V 


II 


*Bty    *J| 


Plate  60-Precordial  Compress  and  Ice  Bag-the  "Hydrotherapeutic  Digitalis. 


THE  TECHXIQUE  OE  HYDROTHERAPY.  125 

what  is  better,  use  rubber  tubing.  Leiter  coil  or  ice-bag,  by  means  of 
which  a  uniform  temperature  can  be  kept  up  for  some  time.  As  the 
skin  absorbs  the  cold  a  decided  impression  is  made  upon  the  peripheral 
nerves  underneath  the  compress.  With  the  prolonged  cold  the  sensory 
and  other  nerves  become  very  much  benumbed,  thereby  abolishing  all 
the  intricate  reflex  actions  that  arise  from  an  ordinary  application  of 
cold  by  the  semi-anesthesia  induced.  This  is  followed  by  a  secondary 
dilatation  of  blood-vessels  in  vascular  areas  associated  with  the  com- 
press, which  serves  to  further  drain  the  blood  from  the  part  treated, 
although  there  is  a  constant  tendency  on  the  part  of  the  circulation  to 
overcome  the  cold  by  an  afflux  of  arterial  blood  to  the  area.  Exuda- 
tion, tissue  change  and  circulation  are  restricted  because  of  the 
lessened  quantity  of  blood  and  diminished  local  nerve  action.  The 
blood  stream  becomes  slower,  the  surface  bluer  from  the  presence  of 
reduced  hemoglobin  in  the  veins.  The  contraction  of  the  vessels  of 
the  area  remains  so  long  as  the  temperature  is  maintained.  Its 
influence  upon  the  blood  itself  is  to  diminish  the  hemoglobin  and 
thereby  decrease  its  oxidizing  power,  increase  the  reduced  hemoglobin 
in  the  veins,  lessen  exudation  of  the  serum,  retard  leucocytosis  and 
decrease  the  red  corpuscles.  The  temperature  of  the  part  is  reduced 
from  two  to  five  degrees,  and  this  can  be  maintained  by  a  careful  and 
judicious  changing  of  the  compress.  This  diminution  in  temperature 
we  are  prepared  to  accept  when  we  realize  the  lessened  circulatory 
and  tissue  change  taking  place.  It  is  for  these  reasons  in  the  early 
stages  of  inflammatory  troubles  that  the  cold  or  cooling  compress  has 
gained  its  reputation  as  an  antiphlogistic,  its  usefulness  being  greatest 
where  the  circulation  is  still  active  or  open  in  the  part  affected. 

Upon  the  muscular  system  it  is  an  inhibitant,  lessening  activity 
and  movement — true  of  both  striated  and  non-striated  tissue.  Its 
action  reflexly  upon  muscular  tissue  is  best  noted  in  the  application 
of  a  compress  or  the  ice-bag  over  the  heart  in  case  of  a  cardiac  in- 
sufficiency or  rapidity.  After  a  moment  cardiac  action  is  fuller  and 
blood  pressure  raised.  Long-continued  application  of  cold  over  the 
heart  depresses  cardiac  activity. 

Where  the  cold  or  cooling  compress  is  continuously  applied  to  the 
head  the  influence  is  less  marked  upon  the  circulation  than  any  other 
region  of  the  body.  The  general  systemic  temperature  may  be 
reduced,  for  the  bones  of  the  skull,  being  thin  and  covered  with  soft 
parts  that  are  free  from  subcutaneous  fat  and  thick  muscular  layers, 
the  cold  conveyed  by  conduction  to  the  cerebral  thermic  centers  lessens 
heat  production. 

Therapeutics  of  the  Cold  and  Cooling  Compress. — From  the  fore- 
going physiological  action  it  is  at  once  apparent  that  the  chief  and 
most  valuable  use  for  this  compress  is  in  localized  inflammations  and 
where  it  is  desired  to  limit  the  quantity  of  blood  circulating  in  a  part. 


126  PRACTICAL  HYDROTHERAPY. 

Applied  to  the  head  it  relieves  headaches,  especially  where  the  pains 
are  of  a  "nervous"  type,  or  associated  with  hyperemic  or  "congestive" 
states.  Care  must,  however,  be  exercised  in  continuous  application, 
as  stubborn  and  persistent  pains  of  a  neuralgic  character  may  follow 
its  use.  In  the  delirium  of  fever,  in  meningitis,  mania,  "cerebral 
congestion,"  it  is  valuable,  relieving  pain,  reducing  fever  and  in- 
flammation. 

The  hydriatist  finds  it  a  valuable  measure  to  prevent  retrostasis 
that  would  otherwise  occur  at  the  time  of  the  application  of  heating 
procedures.  In  women  who  refuse  to  have  the  hair  made  wet  the  cold 
or  cooling  compress  applied  around  the  throat  will  serve  the  same 
beneficent  purpose.  In  inflammatory  diseases  of  the  chest  it  has  some 
ardent  advocates,  Mays2  speaking  especially  of  the  local  use  of  the 
ice-bag.  In  this  field  its  action  is.  in  my  opinion,  limited,  the  stimu- 
lating compress  being  better.  From  a  wide  experience  with  the  cold 
compress  and  ice-bag  in  cardiac  diseases  the  author  can  speak  of  its 
remarkable  and  valuable  efficiency.  This  is  so  true  that  I  have  often 
wondered  why  the  general  practitioner  never  uses  it  in  the  cardiac 
insufficiency  of  fevers  or  diseases  of  the  heart  itself.  In  endocarditis 
and  myocarditis  it  controls  the  inflammatory  process,  strengthens 
heart  action  and  relieves  distress,  the  only  contraindication  being 
degeneration  of  the  heart  muscle  itself.  Syncope  due  to  heart  failure, 
as  well  as  cases  of  rapid  pulse  functional  in  character,  soon  respond 
to  its  use.  I  have  found  it  the  most  satisfactory  method  of  reducing 
the  rapid,  feeble  and  thready  pulse-rate  of  exophthalmic  goitre,  using 
it  intermittently,  two  to  four  times  daily,  for  twenty  to  thirty  minutes 
at  a  time.  Applied  over  the  stomach  and  used  in  conjunction  with 
small  pieces  of  ice  swallowed,  it  is  an  efficient  antidote  to  vomiting. 
Placed  upon  the  spine  opposite,  just  below  the  wing  of  the  scapula, 
it  relieves  pains  of  all  kinds  in  the  stomach,  even  those  of  cancer  and 
ulcer.  The  ice-bag  and  compress  used  over  the  stomach  and  intestine- 
reduce  hemorrhage.  Used  half  an  hour  before  meals,  it  increa-es 
appetite  and  the  secretion  of  gastric  juice.  In  appendicitis  it  may  be 
employed  as  a  supplemental  measure  to  Ochsner's  method. 

In  typhoid  fever  the  cooling  compress  is  a  useful  adjuvant  to  the 
cold  sponge,  and  should  be  placed  over  the  large  areas  of  the  back, 
chest  and  abdomen,  especially  the  latter.  In  inflamed  and  prolapsed 
hemorrhoids,  and  the  testicle  in  orchitis,  pain  is  relieved,  inflammation 
diminished  and  comfort  secured.  Applied  to  the  throat,  it  relieves- 
inflammations,  whether  they  be  of  an  ordinary  bacterial  or  post- 
operative kind :  in  fact,  in  preventing  post-operative  inflammations, 
this  compress  has  been  of  signal  service  in  the  hands  of  the  author, 
particularly  where  it  is  later  followed  with  the  stimulating  compress. 
In  the  early  stages  of  inflamed  joints,  wounds  and  like  conditions  in 

2  Transactions    Philadelphia   Medical    Society,    1895,   p.    302. 


Plate  65 — Permanent  Throat  Bandage. 


Plate  66 — Joint  Compress. 


Plate  67 — Throat  Compress. 


THE  TECHNIQUE  OE  HYDROTHERAPY.  127 

the  extremities,  it  has  a  markedly  sedative  and  eurative  effect.  If  the 
ice-hag  is  laid  across  the  trunk  of  an  artery  it  is  more  effective  in 
reducing  the  hlood  supply  of  the  part  to  which  the  artery  is  dis- 
tributed than  an  application  made  directly  to  the  part  itself;  and  an 
application  made  to  the  axilla,  the  bend  of  the  elbow  or  knee  will 
control  inflammation  in  the  distal  portion  of  the  limb  more  effectively 
than  a  cold  application  to  a  hand  or  foot.  It  must  be  borne  in  mind 
in  making  an  application  of  the  ice-bag  or  of  ice  in  any  form  that  a 
compress  be  placed  between  it  and  the  skin,  preferably  wrung  out  of 
very  cold  water. 

Physiological  Action  of  the  Stimulating  Coin  press. — The  aim  in 
this  compress  is  to  secure  reaction,  and  unless  this  is  attained  its 
object  is  defeated.  Its  effect  is  very  similar  to  that  of  the  pack,  to  be 
hereafter  described,  except  that  it  is  more  localized  and  circumscribed. 
The  cold  of  the  stimulating  compress  causes  the  cutaneous  blood- 
vessels to  contract  vigorously,  through  direct  and  reflex  action,  driving 
the  blood  out  of  the  area  and  lessening  the  circulation.  Varying  with 
the  temperature  of  the  compress  and  the  reactive  capacity  of  the 
patient,  there  ensues  a  dilatation  or  hyperemia  of  the  parts  surrounded 
by  or  in  contact  with  the  compress.  With  the  increased  circulation 
of  arterial  blood  in  the  part  the  compress  becomes  heated,  the  im- 
pervious flannel  covering  preventing  dissipation  and  favoring  accumu 
lation  until  the  compress  gradually  attains  and  rises  slightly  above 
the  temperature  of  the  parts  with  which  it  is  in  contact.  If  continued 
the  compress  gradually  becomes  dry,  evaporation  of  the  water  taking 
place.  By  reflex  action  of  the  vasomotors  the  deeper  blood-vessels 
related  to  the  parts,  both  anatomically  and  reflexly,  contract,  enhancing 
the  blood  supply  beneath  the  compress.  Its  influence  upon  the 
peripheral  nerves  is  sedative,  for  it  envelops  them  in  a  moist  warm 
vapor,  making  the  nerve  terminations  more  succulent,  thus  reducing 
their  irritability.  When  the  action  is  fully  established  it  diminishes 
irritation  in  nervous  structures  reflexly  related  to  the  area.  Local 
tissue  change  is  enhanced,  the  active  and  improved  blood  supply 
removing  waste  material.  Upon  muscles  it  has  a  tonic  influence, 
enhancing  tissue  change  in  them  and  improving  their  tone.  Winter- 
nitz3  has  called  our  attention  to  the  fact  that  the  blood  itself  is 
influenced  by  local  stimulating  compresses,  increased  the  hemoglobin, 
red  blood  cells,  and  in  moderate  degree  leucocytosis,  there  being  a  par- 
ticularly noticeable  increase  of  the  red  blood  cells. 

It  will,  of  course,  be  realized  that  with  the  increased  temperature 
and  other  physiological  reactions  bacteria  and  toxins  are  neutralized 
and  more  rapidly  removed  from  the  part.  Should  chilliness  be 
experienced  it  will  be  due  to  a  failure  of  the  part  to  react,  which  can 
be    counteracted    by    at    once    removing    the    compress    and    applying 

3   Blatter   f.   klinische    Hydrothcapie,   p.    94. 


128  PRACTICAL  HYDROTHERAPY. 

friction  or  colder  water.  Where  patients  have  feeble  reactive  power 
it  is  well  to  first  commence  with  milder  temperatures. 

Therapeutics  of  the  Stimulating  Compress. — In  inflammatory  dis- 
eases of  the  throat,  and  especially  in  tonsillitis,  this  compress  is  most 
effective,  and  under  its  influence  the  process  rapidly  ceases.  In  post- 
operative cases,  where  stimulating  compresses  have  been  carefully 
and  persistently  used  by  the  author,  healing  has  been  accelerated 
nearly  40  per  cent.  This  compress  should  be  more  utilized  by  the 
throat  specialists  than  it  is.  In  chronic  catarrhal  conditions  of  the 
tonsils,  pharynx  and  larynx,  the  persistent  and  painstaking  use  of 
compresses  will  do  much.  In  pneumonia  we  find  a  valuable  adjuvant 
in  the  chest  compress  applied  as  Baruch4  says,  "every  few  hours 
when  the  temperature  is  above  102.5°,  and  removed  when  it  falls 
below  100°  F.  The  cold  compress  produces  deep  inspiration,  con- 
tracts the  cutaneous  vessels,  which  rapidly  dilate,  and  soon  forms  a 
soothing  poultice,  maintaining  tonic  dilatation,  which  aids  the  heart  in 
propelling  the  blood  through  the  contraction  of  the  vascular  ends 
which  warm  applications  would  paralyze  by  relaxation.  That  tem- 
perature is  also  reduced  by  wet  compresses  in  pneumonia  has  repeat- 
edly been  observed."  In  chronic  bronchitis  where  access  cannot  be 
had  to  other  measures,  the  stimulating  compress  offers  an  excellent 
means  of  allaying  cough,  increasing  expectoration  and  bringing  about 
resolution. 

The  stimulating  compress  has  received  the  commendation  of 
the  best  authorities,  not  only  for  its  influence  in  encouraging  vital 
resistance  in  the  diseased  structures,  but  for  the  purpose  of  main- 
taining and  lengthening  the  reduction  of  temperature  secured  by  the 
Brand  or  full  bath.  It  finds  a  useful  field  in  all  forms  of  inflammatory 
trouble  of  the  gastro-intestinal  tract  (gastritis,  enteritis,  colitis, 
hepatitis,  appendicitis,  peritonitis).  During  the  interappendicial 
period  the  wearing  of  a  wet  stimulating  compress  over  the  right  iliac 
region  is  a  valuable  means  of  preventing  a  recurrence  of  the  con- 
dition, and  should  be  used  more  by  the  physician  and  surgeon  than  they 
are  in  the  habit  of  doing  at  the  present  time.  In  the  various  forms 
of  rheumatism  this  compress  may  be  used  as  well  as  in  many  cases 
of  old  exudations  in  the  extremities  or  near  the  surface  of  the  body. 
It  should  be  distinctly  understood,  however,  that  in  these  cases  there 
are  very  much  more  satisfactory  methods  in  handling  the  case  than 
by  means  of  the  compress,  especially  the  use  of  superheated  hot  air 
followed  by  the  more  active  hydriatic  measures.  In  old  ulcers  of  the 
leg  the  application  of  a  wet  gauze  compress,  together  with  the  spiral 
reverse  bandage,  is  a  method  sanctioned  by  long  and  successful 
usage. 

4  Baruch,   Simon:     "Hydrotherapy,"   1897,  p.   295. 


. 


Plate  61— Chest  Compresses. 


Plate  62— Chest  Compress— First  Stage. 


#" 


^1 

/ 


i 


Plate  63 — Chest  Compress — Second  Stage. 


|l 


Plate  64 — Chest  Compress— Completed. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  129 

Hot  Compress. 

This  compress  is  applied  similarly  to  the  stimulating  one,  the  ob- 
ject being  to  retain  the  heat.  The  material  used  should  be  ample, 
and  larger  than  the  area  to  be  covered.  The  linen,  blanket,  cheese- 
cloth, etc.,  may  be  covered  or  protected  by  flannel  or  any  other  suit- 
able material.  The  method  I  generally  employ  is  to  have  the  patient 
lie  upon  the  couch  or  bed;  the  part  to  be  treated  is  exposed  and  lubri- 
cated with  vaseline.  The  compress  is  applied  at  the  temperature  de- 
sired, care  being  taken  to  wring  the  material  sufficiently  dry  to  pre- 
vent burning.  If  the  clothing,  bed  or  couch  gets  wet,  it  is  likely  to 
chill  the  patient  and  later  cause  a  "cold."  The  rapidity  with  which 
a  nurse  works  will  have  something  to  do  with  the  efficiency  and  results 
of  the  hot  compress.  The  duration  of  the  application  varies  accord- 
ing to  the  temperature  of  the  compress,  the  temperature  of  the  room 
and  the  amount  of  water  contained  in  the  compress  itself.  It  is  a 
good  plan,  after  several  very  hot  compresses,  to  apply  a  hot-water 
bottle  over  the  compress.  Compresses  are  usually  used  to  relieve 
pain ;  a  safe  rule  is  to  remove,  re-wet  and  replace  them  every  half-hour 
as  long  as  the  pain  is  mitigated.  Every  hour  a  momentary  stimu- 
lating effect  can  be  obtained  by  using  a  cold  (50°  to  60°  F.)  compress 
for  thirty  seconds,  then  reapplying  the  hot  compress.  It  should  be 
remembered  that  a  hot  compress  is  always  to  be  followed  by  a  brief 
tonic  application  of  cold,  which  should  not  exceed  one-half  minute. 
The  parts  are  then  well  dried,  finished  with  manual  friction,  covered 
with  the  patient's  underwear  or  some  other  covering,  remembering 
that  evaporation  and  slow  chilling  defeat  the  object  of  this  procedure. 

"In  an  emergency  a  flannel  cloth  or  a  cloth  of  any  sort  may  be 
wrung  out  of  water  and  wrapped  around  a  stovepipe,  or  laid  upon 
the  top  of  a  stove,  or  held  against  its  side  for  a  few  seconds  until 
heated.  To  prevent  soiling  by  contact  with  the  stove,  the  cloth  may 
be  placed  between  the  folds  of  a  newspaper;  the  newspaper,  being 
moistened,  will  not  burn."     (Kellogg.) 

The  final  application  of  cold  produces  a  reaction,  tonic  and  circula- 
tory in  character.     (See  Fomentation.) 

Physiological  Action  of  the  Hot  Compress. — The  immediate  influ- 
ence of  the  hot  compress  is  hardly  pleasurable,  and  produces  con- 
siderable excitation  for  a  short  time.  Its  action,  though  similar  to 
the  fomentation,  is  not  nearly  so  powerful  or  excitant.  Immediately 
upon  its  application  there  occurs  a  transient  contraction  of  the  blood- 
vessels, quickly  followed  by  dilatation.  After  a  short  while,  vaso- 
motor paresis  takes  place ;  the  vessels,  large  and  small,  dilate  enor- 
mously, the  skin  assuming  a  red  and  turgid  appearance.  This  paresis 
of  the  blood-vessels  produces  a  slowed  circulation,  and  is  a  "passive 
hyperemia."     By  local  and  reflex  action  of  the  vasomotors  the  ves- 


130  PRACTICAL  HYDROTHERAPY. 

sels  of  the  deeper  structures  related  to  the  parts,  both  anatomically  and 
reflexly,  contract,  while  those  at  the  surface  fill  with  blood,  a  collateral 
anemia  taking  place  in  the  deeper  associated  areas.  This  collateral 
anemia  is  an  explanation  of  why  hot  compresses  relieve  deep-seated 
inflammations.  Upon  the  peripheral  nerves  it  is  at  first  excitant,  soon 
followed  by  marked  sedative  effects.  The  pain  sense  is  dulled;  the 
nerve  terminations  enveloped  in  hot  vapor  are  rendered  succulent 
and  their  irritability  reduced.  Reflex  action  is  lessened,  local  tissue 
change  is  enhanced,  migration  of  white  cells  increased,  and  the  lymph 
stream  made  active.  Upon  the  muscular  system  it  has  a  relaxing 
effect,  too  well  known  to  comment  upon,  probably  no  remedy  being 
so  efficacious  in  cramps  of  all  kinds.  Upon  the  blood  Baruch5  noted 
the  following: 

"In  order  to  ascertain  the  effect  of  warm  compresses,  the  compo- 
sition of  blood  from  the  finger  tip  and  from  the  skin  over  the  abdo- 
men was  studied.  The  finger  tip  blood  showed  95  per  cent,  of  hemo- 
globin-and  5,300,000  red  cells;  the  blood  from  the  abdominal  skin 
showed  120  per  cent,  of  hemoglobin  and  7,000,000  red  cells;  while 
the  leucocytes  were  7,000,  about  the  same  in  both  specimens.  After 
a  warm  compress  (127°  F.)  had  lain  for  one  and  one-half  hours 
upon  the  abdomen  a  comparison  was  again  instituted,  showing  that 
in  the  blood  from  the  finger  tip  the  hemoglobin  had  increased  10  per 
cent,  and  the  red  cells  90,000;  the  leucocytes  had  also  increased  1,000. 
But  the  blood  taken  from  the  skin  of  the  abdomen  beneath  the  cata- 
plasm had  lost  22  per  cent,  of  its  hemoglobin  and  2,500,000  of  its  red 
cells,  while  the  leucocytes  were  doubled." 

Influencing  circumscribed  and  local  inflammations  by  leucocytosis, 
suppuration  is  brought  about  when  this  is  desired,  constituting,  as 
it  does,  a  ciean,  neat  and  valuable  substitute  for  the  old-fashioned 
poultice.  It  quickens  metabolic  changes,  encourages  absorption  of 
exudates,  and  probably,  through  its  high  temperature,  helps  nature 
to  destroy  morbific  products,  just  as  fever  is  now  considered  by  many 
to  be  beneficent,  and  to  aid  the  natural  resources  in  their  fight  against 
enemies,  toxic  and  bacteric  in  character. 

Therapeutic  Action  of  the  Hot  Compress. — It  is  valuable  for  its 
pain-relieving  qualities.  In  acute  pains,  due  to  trauma,  irritation, 
stasis  or  swelling,  whether  located  in  muscle,  skin,  nerve,  bone  or 
joint;  spasms,  synovitis,  toothache,  earache,  anemic  headaches,  mi- 
graine, inflammations  of  the  throat,  tonsils,  etc.,  great  relief  is  given. 
It  may  be  employed  to  stimulate  absorption  and  remove  swellings 
or  effusions.  In  inflammatory  conditions  of  the  abdominal  and  pelvic 
viscera,  by  its  pain-relieving,  relaxing  and  absorbing  influence,  it  may  be 
applied  directly  over  any  of  these  organs,  the  congestion  of  which  will 
be  relieved  by  the  afflux  of  blood  to  the  skin.  In  chronic  pains,  even 
of  organic  disease,  if  applied  thoroughly,  it  will  do  major  service  and 

5   Loc.   cit      p,    124. 


m 


r 


Plate  68— Pelvic  Pack— Ready. 


Plate  69— Pelvic  Pack— First  Stage. 


Plate  70— Pelvic   Pack— Second   Stage. 


*-*• 


„^»X.  ..—^r 


Plate  71— Pelvic  Pack— Completed. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  131 

give  much  temporary  relief.  In  all  forms  of  gastro-intestinal  inflam- 
mation, in  hemorrhoids,  after  divulsion  of  the  sphincter  ani,  this 
compress  is  indicated.  It  must  be  stated,  however,  that,  as  a  rule, 
the   fomentation  gives  better  results. 

The  Cephalic  Compress. 

The  head  compress  is  probably  the  most  generally  used-  of  these 
applications,  and  is  utilized  by  the  lay  member  more  or  less  constantly 
in  the  treatment  of  various  conditions  of  cerebral  discomfort.  One 
of  the  most  satisfactory,  and  at  the  same  time  simple,  methods  of 
applying  the  compress  to  the  head,  is  by  means  of  a  towel  in  the  form 
of  a  turban.  A  towel  of  sufficient  length  and  size  is  placed  under 
the  patient's  head,  on  a  line  with  the  top  of  the  ears;  the  left  end  is 
first  brought  over  the  forehead  and  carried  around  to  the  occiput ; 
the  right  side  is  carried  around  in  the  same  manner  and  the  open  end 
turned  to  form  a  closed  end,  resting  on  the  forehead,  somewhat  re- 
sembling the  Tarn  O'Shanter  cap.  The  towel  should  be  clipped  in 
water  at  a  temperature  ranging  from  40°  to  60°  F.,  and  repeated  at 
short  intervals.  The  writer  has  also  utilized  the  head-coil  and  ice-bag 
in  connection  with  the  compress,  and  has  found  that  it  is  very  much 
more  satisfactory  than  the  use  of  the  head-coil  or  a  compress  alone; 
in  fact,  the  head-coil  should  never  be  applied  without  some  light  com- 
press between  it  and  the  scalp.  The  cold  compress  is  used  by  the 
hydriatist  constantly  during  the  application  of  heat  upon  the  surface 
of  the  body,  for  such  measures  tend  to  produce  retrostasis,  or  "rush 
of  blood  to  the  head."  It  therefore  finds  a  useful  place  during  the 
application  of  the  electric  light,  arc,  hot-air  baths,  and  during  the  ad- 
mininstration   of  the  various   forms  of  packs. 

The  Throat  Compress. 

The  throat  compress  is  rarely  properly  applied,  for,  while  it  is 
generally  termed  throat  compress,  the  aplication  in  ordinary  hands  is 
more  often  to  the  neck,  rather  than  to  the  organs  of  the  throat  and 
upper  throat.  The  writer  has  found  in  his  experience  that  the  in- 
volvement of  pharynx,  tonsil  and  larynx  is  so  common,  both  by  simul- 
taneous invasion  or  rapid  extension  from  one  to  the  other,  that  he 
has  gradually  evolved  the  following  method  of  applying  the  throat 
compress:  A  piece  of  old  linen  is  taken  of  sufficient  length  to  pass 
around  the  neck  and  over  the  head  once,  after  being  folded  twice 
upon  itself  to  make  four  layers.  Starting  on  the  left  side  of  the  head 
below  the  left  ear,  the  compress  is  carried  over  the  top  of  the  head, 
over  the  right  ear,  and  then  encircling  the  throat.  In  like  manner 
a  flannel  bandage  is  carried  over  the  linen  compress  several  times, 
and  applied  with  sufficient  tension  to  cause  the  compress  to  fit  closely 
and  snugly  in  contact  with  the  skin.     Slits  are  then  made  in  both  the 


132  PRACTICAL  HYDROTHERAPY. 

compress  and  flannel  roller,  to  permit  the  egress  of  the  ears.  The 
writer  has  found  in  his  experience  that  it  is  much  better  to  cut  and 
measure  the  compress  and  bandage  before  putting  them  on  the  pa- 
tient's head.  The  linen  is  immersed  in  water  at  a  temperature  from 
50°  to  60°  F.,  and  wrung  out  sufficiently  dry  to  prevent  dripping. 
Where  it  is  necessary,  as  in  restless  adults  or  children,  to  secure  the 
compress  tightly,  it  is  well  to  take  a  turn  or  two  with  the  roller  from 
the  forehead  to  the  occiput,  thus  encircling  the  head.  The  whole  com- 
press will  be  made  more  secure  and  retain  its  position  better  if  the 
crossings  are  pinned  with  small  safety-pins.  The  object  of  this 
compress  is  to  bring  under  its  influence  the  skin  and  organs  contained 
within  the  two  triangles  that  have  for  their  apex  the  ear  and  for  the 
base  the  clavicle,  for  unless  the  compress  reaches  up  and  over  the 
angle  of  the  jaw,  it  is  practically  valueless,  as  the  tonsils  are  prin- 
cipally involved.  It  is  generally  used  for  acute  inflammatory  troubles. 
A  special  "permanent  bandage"  in  the  shape  of  a  spring  collar  has 
lately  been  placed  upon  the  market,0  which  enables  this  useful  com- 
press to  be  easily  applied.  It  is  made  of  elastic  celluloid,  with  raised 
sides,  the  inner  side  of  which  is  lined  with  soft  felt,  which  is  moist- 
ened with  water  at  the  desired  temperature  before  it  is  used  (see  cut). 
It  is  quickly  adjusted  and  remains  well  in  place.  It  is  made  in  sizes 
ranging  from  ten  to  twelve  inches  to  fifteen  to  eighteen  inches,  and 
is  very  moderate  in  price. 

The  Chest  Compress. 

The  compress,  when  used  upon  the  chest,  is  usually  a  stimulating 
one — in  reality,  a  chest  pack — and  for  this  reason  it  must  be  so  ap- 
plied as  to  exclude  all  air.  The  simplest  way  is  to  make  several 
jackets  (see  cut).  Take  a  piece  of  linen  large  enough  to  go  around 
the  chest,  and  lap  eight  or  ten  inches,  and  to  extend  from  the  clavicle 
to  about  the  last  rib.  Place  this  beneath  the  patient,  and  draw  around 
the  body  until  the  ends  lap.  Now  cut  slits  for  the  arms,  which  are 
then  enlarged  to  snugly  fit  these  members;  then  stitch  the  three  lay- 
ers together.  In  the  same  manner  prepare  two  flannel  jackets,  an 
inch  longer  at  the  neck  and  two  inches  at  the  abdominal  end.  Being 
ready  to  apply  the  compress,  dip  it  in  water  at  a  temperature  from  50° 
to  60°  F.,  and  wring  out  until  it  no  longer  drips.  Xow  spread  out 
the  flannel  jackets  and  lay  upon  them  the  wet  compress,  being  care- 
ful to  get  the  slits  in  the  compress  and  flannel  jackets  in  proper  appo- 
sition; fold  or  roll  from  each  end  until  the  compress  presents  a 
double  roller  appearance  (see  cut).  Turn  the  patient  gently  on  the 
right  side,  without  the  slightest  exertion  on  his  part;  place  the  rolled 
compress  on  the  bed  and  unroll  the  left  half,  slipping  the  left  arm 
into  the  left  slit  (see  cut),  and  quickly  placing  the  compress  upon  the 

6  Kny-Scheerer   Co.,   224   Fourth    Avenue,   New   York  City. 


Plate  72— Full  Wet  Pack— Fir^t  Stage. 


Plate  73— Full  Wet  Pack— Second  Stage. 


Plate  74— Full  Wet   Pack— Third   Stage. 


Plate  75— Full  Wet  Pack— Fourth  Stage. 


E    TECHNIQUE  OF  HYDROTHERAPY.  133 

chest  Repeat  the  same  process  with  the  right  side,  and  then  allow 
the  patient  to  lie  upon  the  hack;  the  ends  of  the  compress  are  first 
lapped,  then  the  underneath  flannels  carried  closely  and  snugly  over  the 
compress.  \n  like  manner  the  outer  flannel  is  tightly  adjusted  and 
secured  by  safety-pins  in  front.  The  upper  edges  arc  now  neatly 
tucked  around  the  neck  and  secured  by  safety-pins  upon  the  shoulders. 
A  soft  towel  or  strip  of  linen  is  then  tucked  in  at  the  neck  to  prevent 
the  disagreeable  irritation  of  the  flannel  (see  cut).  The  chest  pack  is 
of  value  in  inflammatory  processes  of  the  lungs  and  pleura. 

The  Trunk  Compress. 

The  trunk  compress  may  extend  from  the  axilla  to  and  over  the 
hips,  thus  embracing  the  chest,  abdomen  and  pelvis.  Where  it  is  lim- 
ited to  the  chest,  abdomen  or  pelvis,  it  is  generally  called  by 
the  name  of  the  anatomical  region  embraced.  In  its  essential  fea- 
tures it  is  one  and  the  same.  If  it  is  to  be  used  as  a  cold  or  cooling 
measure,  one  or  two  heavy  crash  towels  are  wrung  out  of  water  at  the 
desired  temperature  (40°  to  70°  F.),  applied  to  the  region,  and  re- 
newed as  frequently  as  they  become  warm.  If  a  stimulating  or  hot 
compress  is  used,  a  single  blanket  is  folded  once  lengthwise  and 
placed  under  the  patient's  back  (see  cut),  the  compress,  wrung  out 
of  water  at  the  proper  temperature,  placed  in  position  (see  cut),  and 
the  blanket  wrapped  tightly  over  same.  If  a  pelvic  pack  alone  is 
given,  we  may  better  apply  same  by  a  sheet  and  two  blankets,  which 
are  prepared  as  follows :  The  first  blanket  is  folded  lengthwise  and 
placed  across  the  bed  so  that  the  patient's  back  rests  upon  the  middle. 
The  second  blanket  is  then  folded  so  as  to  form  a  triangle,  the  apex 
of  which  is  placed  between  the  patient's  legs.  The  sheet  is  similarly 
folded — about  two  inches  smaller,  however — and  fitted  on  the  second 
blanket  (see  cut).  This  compress  or  pack  is  generally  given  very 
hot,  and  is  known  as  the  "hot  pelvic  pack"  or  compress.  The  patient 
elevates  the  night  dress,  exposing  the  pelvis,  and  lies  so  that  the  apex 
of  the  second  blanket  is  between  the  legs.  The  nurse  now  pours  boil- 
ing water  over  the  sheet  (the  wringer  is  very  useful,  see  Fomenta- 
tion), rapidly  places  it  in  position,  draws  up  the  apex  point  between 
the  legs  fiist,  then  the  two  side  ends,  until  the  sheet  now  resembles 
an  infant's  napkin  (see  cut).  In  like  manner  the  triangular  blanket  is 
applied,  and  over  all  the  blanket  folded  lengthwise.  This  must  be 
snugly  done,  air  excluded,  and  secured  in  place  by  safety-pins  (see 
cut).  A  rubber  sheet  will  further  prevent  heat  loss.  The  hot  pelvic 
pack  is  a  favorite  method  with  the  author. 

A  stimulating  compress,  much  used  in  Germany,  and  called  "Nep- 
tune's girdle,"  consists  of  a  linen  bandage  ten  to  twelve  inches  in 
width  and  three  to  four,  yards  in  length.  One-third  to  one-half  of 
this  length  is  wrung  out  of  water  at  50°  to  60°  F.,  applied  to  the  ab- 


134  PRACTICAL  HYDROTHERAPY. 

domen  or  pelvis,  as  the  case  may  be,  and  the  dry  half  wrapped 
around  the  wet  and  pinned.  It  is  of  undoubted  value  in  gastrointes- 
tinal affections,  in  which  field  it  has  obtained  its  greatest  popularity. 

The  Joint  Compress. 

This  is  simply  a  piece  of  linen  wet  in  water  at  50°  or  60°  F.,  en- 
veloping the  joint,  and  secured  in  position  by  a  flannel  bandage  or 
some  other  proper  material.  Its  action  is  obvious,  and  it  is  princi- 
pally used  in  inflammations  of  the  extremities  (see  cuts). 

The  Wet  Pack. 

The  full  wet  pack  is  one  of  the  most  useful  and  valuable  of  all 
hydriatic  procedures,  and  should  be  more  extensively  employed,  for 
it  can  be  utilized  in  home  or  hospital  practice,  and  where  judiciously 
used  will  yield  results  the  equal  of  many  more  vaunted  procedures. 
There  is  no  method,  in  my  opinion,  in  the  wide  range  of  hydrotherapy, 
that  it  is  so  often  faultily  applied  as  the  wet  pack.  It  is  best  applied 
upon  a  cot  or  bed,  over  the  mattress  of  which  a  rubber  sheet  has 
been  spread.  The  following  manner  of  proceeding  has  been  found 
best  by  the  author: 

Two  large  woolen  blankets,  preferably  gray  in  color,  are  spread 
upon  the  mattress  and  allowed  to  hang  over  the  cot  equally  on 
either  side.  The  blankets  should  be  long  enough  to  extend  at  least 
eight  to  twelve  inches  below  the  feet,  and  the  end  above  must  come  to  a 
level  with  the  ears.  A  rough  linen  sheet  is  now  well  wrung  out  of 
water  at  a  temperature  varying  from  50°  to  80°  F.,  appropriately 
graduated  to  suit  the  case.  The  sheet  is  spread  upon  blankets  so 
as  to  leave  a  few  inches  of  blanket  margin  at  the  neck  end.  The 
patient,  completely  disrobed,  places  himself  upon  the  middle  of  the 
sheet,  with  his  arms  and  legs  slightly  separated  from  contact  with 
the  body  or  themselves.  The  patient  should  be  made  to  lie  so  as  to 
allow  three  inches  of  the  sheet  to  project  above  the  shoulders. 

The  nurse,  standing  on  the  left  side  of  the  cot,  grasps  the  upper 
left  hand  corner  of  the  sheet,  and  has  the  patient  raise  the  arms; 
the  sheet  is  then  brought  under  the  left  arm,  across  the  chest,  and  is 
tucked  snugly  around  the  neck  and  under  the  right  side  of  the  trunk; 
the  right  leg  is  then  raised  and  the  sheet  carried  over  the  left  leg  and 
under  the  right  one.  The  arms  are  now  lowered  and  the  upper  right 
hand  corner  of  the  sheet  brought  over  the  right  arm,  over  the  chest, 
over  the  left  arm,  and  is  then  tightly  tucked  under  the  left  side  of  the 
trunk.  The  upper  edge  should  now  be  folded  and  tucked  around 
the  neck  and  under  the  chin.  The  lower  edge  is  then  carried  over  the 
right  leg  and  tucked  under  the  left,  and  the  open  end  below  the  feet 
loosely  folded  over  the  toes  and  feet  and  tucked  under  the  heels.  A 
fold  over  each  shoulder  will  help  to  make  the  sheet  lay  smoothly 


Plate  76— Full  Wet   Pack— Fifth   Stage. 


W 


Plate  77— Full  Wet   Pack— Sixth   Stage. 


Plate  78— Full  Wet  Pack— Seventh  Stage. 


r 


Plate  79— Full  Wet  Pack— Completed. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  135 

around  the  neck.  If  properly  done,  every  bit  of  the  cutaneous  sur- 
face is  in  contact  with  the  sheet,  except  that  of  the  face  and  head. 

The  next  step  is  to  apply  the  blankets.  In  a  manner  similar  to 
the  application  of  the  sheet,  the  upper  left  hand  corner  is  carried 
across  the  trunk.  The  lozver  left  hand  end  is  then  carried  over 
the  left  leg,  and  the  lower  limbs  closely  drawn  together.  The  right 
side  of  the  blanket  is  then  carried  across  and  folded  over  the  shoulder, 
trunk  and  legs.  The  nurse  should  now  endeavor  to  pull  the  blankets 
as  closely  to  the  body  as  possible,  for  unless  this  is  well  done  air  will 
not  be  excluded,  and  the  loosely  applied  blanket  causes  discomfort 
and  fatigue.  The  second  blanket  is  now  applied  over  the  first  in  like 
manner.  The  open  ends  at  the  feet  are  then  folded  closely  together 
and  turned  under  the  feet.  When  completed,  the  patient  is  enveloped 
in  sheet  and  blankets  similar  to  a  mummy.  A  soft  towel  is  next  taken 
and  tucked  around  the  neck  to  prevent  the  woolen  fibers  from  irri- 
tating the  sensitive  skin  of  the  neck  and  face.  This  assists  in  ex- 
cluding air. 

A  cold  wet  turban  or  ice-helmet  should  then  be  applied.  A  simple 
way  of  applying  the  turban  is  as  follows :  Take  two  towels  without 
fringes;  place  one  upon  the  other  and  wring  out  of  very  cold  water ; 
wet  the  patient's  hair  with  cold  water  and  place  his  head  upon  the 
center  of  the  edge  of  the  towels ;  carry  one  side  up  back  of  the  ear 
and  fold  over  the  forehead,  and  repeat  on  the  other  side;  fold  the 
loose  ends  squarely  from  behind  forward,  and  a  neat  cap  is  formed. 
If  this  is  not  permitted,  a  cold  circular  compress  may  be  placed  around 
the  neck,  or  a  cold  compress  laid  on  the  face. 

The  time  usually  required  for  a  skillful  nurse  to  apply  a  pack  is 
about  three  minutes.  It  should  at  this  point  be.  again  noted  that  unless 
all  air  has  absolutely  been  excluded  the  aim  of  the  pack  has  been  de- 
feated. The  sheet  should  be  of  rough  linen,  and  it  may  be  stated 
that  a  fair  average  temperature  is  60°  F.,  though  patients  should  be 
educated  to  this  temperature  by  several  packs  of  a  higher  degree.  If 
the  patient  desires  water  to  drink  during  the  pack,  it  should  be  given. 
A  hot- water  bag  is  comforting  when  applied  to  the  feet,  especially 
in  those  whose  extremities  are  habitually  cold. 

Physiological  Action  of  the  Wet  Pack. — The  first  contact  of  the  cold 
wet  pack  is  disagreeable — a  chililng  sensation  accompanied  by  tremor 
and  shaking.  Irritation  of  the  cutaneous  nerves  by  the  cold,  with 
contraction  of  the  peripheral  vessels,  lasts  until  the  individual's  power 
of  reaction  comes  into  play.  This  depends,  as  in  all  hydriatic  pro- 
cedures, upon  the  condition  of  the  patient.  Nervousness  may  be  in- 
creased, but  will  disappear  and  give  place  to  relaxation  and  calm 
when   full  reaction  takes  place. 

The  efficiency  of  the  application  of  the  pack  itself  will  have  some- 
thing to  do  with  the  patient's  reacting  or  "warming  up,"  for  chill  in 


136  PRACTICAL  HYDROTHERAPY. 

the  pack  may  be  due  to  the  fact  that  at  some  points  the  wet  sheet  is 
not  in  perfect  contact  with  the  surface.  If  this  is  the  case,  evaporation 
takes  place,  with  cooling,  instead  of  heat  accumulation  and  vigorous 
reaction.  If  the  feet  do  not  warm  readily,  they  may  be  left  out 
until  reaction  is  improved,  or,  what  is  better,  the  hot-water  bottle 
applied  for  a  short  while.  This  stage  usually  lasts  from  five  to  fifteen 
minutes,  when,  reaction  commencing,  the  system  makes  an  effort  to 
equalize  its  effects.  The  duration  of  the  pack  should  range  from 
thirty  to  sixty  minutes,  depending  upon  the  effect  desired — the  shorter 
tonic  and  invigorating,  the  longer  sedative.  When  reaction  sets  in 
and  the  peripheral  blood-vessels  dilate,  the  patient  feels  a  delightful 
glow,  a  sensation  of  comfort  and  well-being. 

Upon  the  circulation,  the  pack  at  the  outset  produces  peripheral 
contraction,  driving  the  blood  from  the  skin  into  the  internal  viscera ; 
the  skin  is  pale  and  goose-flesh  appears.  During  this  stage  Mueller, 
in  trephined  rabbits,  noticed  a  rapid  dilatation  of  the  arteries  of  the 
pia  mater.  Usually,  after  a  period  roughly  averaging  ten  minutes 
( this  time  being  required,  as  there  is  complete  lack  of  mechanical  aid 
to  dilatation  of  the  blood-vessels),  reaction  takes  place.  The  periph- 
eral blood-vessels  dilate,  the  skin  assumes  a  pinkish  hue.  the  sheet 
warms  up.  the  patient  being  now  enveloped  in  a  moist  vapor.  The 
entire  bodily  circulation  is  accelerated  and  the  column  of  blood  which 
sets  in  toward  the  viscera  returns  to  the  surface,  assisted  by  the  un- 
obstructed vascular  conditions  and  better  heart  action,  securing  a  more 
complete  exchange  between  cutaneous  and  visceral  blood.  The  pulse 
is  accelerated  at  the  commencement,  but  later  becomes  slowed,  of 
fuller  volume  and  better  tension.  The  wet  pack  is  a  strain  on  the 
individual's  circulation,  as  he  has  to  depend  entirely  on  his  own  vital 
capacity  and  resources  for  reaction. 

Upon  respiration  the  first  impression  of  the  pack  is  one  of  dis- 
comfort and  accelerated  breathing.  The  patient  may  complain  of 
thoracic  constriction,  which  subsides  with  the  onset  of  reaction,  at 
which  time  the  respirations  become  slow  and  deep,  with  increased 
absorption  of  oxygen,  elimination  of  C02  and  other  waste  materials. 
Expectoration  is  increased,  noticeable  in  cases  of  inflammatory  trouble 
of  the  bronchial  tubes. 

Upon  temperature  the  effect  depends  upon  the  duration  of  the 
pack.  During  the  primary  stage  there  is  heat  abstraction,  but  in 
non-febrile  cases  this  is  followed  by  increased  heat  production  and 
accumulation  due  to  the  prevention  of  heat  elimination.  With 
reaction  heat  equalization  takes  place,  with  increased  heat  loss.  With 
this  increase  of  heat  and  the  warming  of  the  sheet,  the  temperature 
generally  rises  sufficiently  to  produce  perspiration.  The  thermic  action 
is  intense  and  the  caloric  response,  like  the  circulatory,  depends  solely 
upon  the  patient's  power  to  respond,  and   it  was  probably   for  this 


4$ 


u 


Plate  80— Half   Wet   Pack. 


Plate  81— Hot  Blanket  Pack. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  137 

reason  Priessnitz  gave  his  packs  early  in  the  morning,  before  patients 
left  their  beds,  while  there  was  an  accumulation  of  heat  in  the  skin. 
If  beat  abstraction  or  antipyretic  effect  be  desired,  the  packs,  according 
to  Liebermeister,  should  be  repeated  every  ten  minutes  until  five  are 
taken.  1  do  not  consider  the  pack  valuable  as  an  antipyretic  measure, 
much  preferring  the  full  bath  or  sponge  and  compress. 

Upon  the  nervous  system  its  action  is  marked.  The  first  periph- 
eral impression  is  a  powerful  one  of  discomfort  and  nervousness. 
With  the  onset  of  reaction  comfort  returns,  after  a  short  while  the 
nervousness  disappears,  a  sense  of  quiet  and  calm  takes  its  place. 
The  warm  vapor  bathes  the  peripheral  nerves,  renders  them  more 
succulent,  less  sensitive,  and  this  is  aided  by  the  absence  of  any 
mechanical  irritation.  With  the  withdrawal  of  blood  from  the  viscera, 
brain,  etc.,  to  the  surface,  drowsiness  and  later  sleep  are  commonly 
produced,  as  central  innervation  dependent  on  the  active  blood  stream 
will  be  lessened,  though  this  is  due  to  a  combination  of  factors.  The 
wet  pack  makes  an  appeal  to  every  nerve  in  the  skin  and  to  all  the 
various  functions  of  the  nervous  system.  The  blood  circulates  in 
increased  volume  and  under  increased  pressure  through  the  nerve 
centers,  and  "in  consequence,  the  acid  fatigue  products,  which  had 
been  maintaining  a  permanent  excitement  of  nerve  elements,  can  be 
completely  removed ;  the  immediate  subsequent  diminution  of  the 
blood  supply  effected  during  the  second  part  of  the  pack,  cannot  fail 
to  be  a  great  advantage,  for  it  lowers  the  functional  activity  of  the 
nerve  tissues  that  has  been  unduly  prolonged,  and  brings  them,  there- 
fore, into  the  condition  which  is  a  necessary  preliminary  to  the  be- 
ginning of  nutritive  assimilation.  The  diminution  of  the  blood  supply 
is  not  sufficient  to  interfere  with  this  latter  process,  for  it  is  not  below 
the  point  which  exists  in  sleep."    (Jacobi.) 

Upon  tissue  change  the  pack  has  a  decided  alterative  effect,  all 
organic  processes  being  vigorously  excited  to  action.  The  heat 
abstraction  by  the  cold  induces  functional  activity;  with  reaction  and 
with  temperature  elevation  there  is  a  considerable  destruction  of 
toxins,  together  with  elimination  of  waste  tissue  products.  Proteid 
destruction  and  oxidation  take  place,  the  nitrogenous  output  being 
much  increased.  The  neuro-vascular  activity  favors  nutritive  assimi- 
lation in  the  various  tissues,  and  it  is  probable  that  auto-toxins  are 
consumed  in  the  powerfully  enhanced  combustion  which  represents 
the  fever  process,  and  that  they  are  thus  eliminated  from  the  organism. 
"The  so-called  curative  power  of  fever  probably  is  due  to  this  oxida- 
tion of  toxins  and  auto-toxins,  and  it  may  also  be  the  reason  why 
sometimes  chronic  diseases  are  removed  by  acute  intercurrent  diseases, 
and  why  many  individuals  feel  much  better  after  acute  febrile  dis- 
eases." 7 

7   Kellogg,  J.   H. :     "Rational   Hydrotherapy,"  p.   608. 


138  PRACTICAL  HYDROTHERAPY. 

Upon  the  muscular  system  the  pack  produces  primarily  con- 
traction, most  marked  in  the  muscular  tissue  of  the  skin,  causing 
goose  flesh.  There  is  rigor  and  tremor  during  the  cold  stage,  but 
later  this  gives  way  to  muscular  relaxation  and  lessened  muscular 
irritation.  Mosso,  Maggiora  and  others  have  shown  that  the  wet 
pack  increases  muscular  activity  and  tonicity,  and  this  explains  the 
increased  strength  felt  after  the  pack.  Their  tables  showed  marked 
improvement  of  lifting  power. 

Upon  the  blood  the  pack  not  alone  moves  the  stream  through  the 
blood-vessels  more  actively,  but  by  causing  increased  elimination 
purifies  it  of  many  detrimental  toxins  and  much  waste  material.  It 
increases  the  oxygen-absorptive  power  of  the  red  cells  and  the  hemo- 
globin. Its  bactericidal  powers  are  enhanced,  owing  to  the  greater 
number  of  leucocytes.  After  a  wet  pack  the  blood  stream  is  richer 
both  in  hemoglobin  and  all  corpuscular  elements,  thus  explaining  its 
value  as  an  adjunct  to  iron  in  the  treatment  of  depleted  blood  states. 

Therapeutics  of  the  Wet  Pack. — If  the  aim  be  antiphlogistic,  the 
pack  must  be  administered  at  about  60°  and  repeated  every  ten  minutes 
until  the  effect  desired  is  attained,  Liebermeister  having  shown  that 
five  such  packs  are  equivalent  to  one  Brand  bath  executed  with 
every  attention  to  detail.  The  wet  pack  at  60°  F.,  like  the  full  bath, 
is  not  administered  with  the  sole  idea  of  reducing  temperature,  but 
finds  its  greatest  indication  outside  of  its  thermo-reducing  value. 
That  the  full  wet  pack  is  a  powerful  tonic,  an  eliminator  of  toxins,  a 
stimulator  of  renal  and  cutaneous  activity ;  that  it  tones  and  refreshes 
the  nervous  system,  steadies  and  improves  cardiac  action,  is  daily 
observed.  In  acute  nervous  affections ;  in  the  restlessness  of  alcohol- 
ism, morphinism  and  other  drug  addictions,  the  wet  pack  serves  as  a 
calmative  and  sedative  of  very  great  value,  and  it  is  to  be  regretted 
that  the  general  practitioner  under  whose  care  these  conditions  most 
frequently  present  themselves  does  not  avail  himself  of  a  method  the 
value  of  which  remains  undisputed  and  the  technique  of  which  is  not 
difficult  to  acquire.  An  added  incentive  is  the  fact  that  all  methods 
of  drug  medication  will  be  enhanced  and  their  physiological  action 
more  nearly  attained. 

In  chronic  diseases  the  wet  pack,  because  of  its  physiological 
action  upon  the  nervous  system,  is  most  valuable.  The  author  has 
found  it  a  satisfactory  remedial  agent  in  the  cure  of  insomnia,  and 
uses  it  most  frequently  just  before  retiring.  In  all  the  functional 
psychoses  and  neuroses,  especially  neurasthenia,  the  wet  pack,  fol- 
lowed by  active  hydriatic  methods,  is  of  value,  though  I  prefer  other 
methods  where  the  patient  is  up  and  going  about.  Where  the 
nutritive  forces  are  low,  where  secretion  and  excretion  are  dimin- 
ished, the  pack  will  serve  a  useful  purpose.  In  these  cases  it  will  be 
noticed    from   day  to   day  that   reaction   is   more   and   more   prompt, 


THE  TECHNIQUE  OF  HYDROTHERAPY.  139 

showing  greater  activity  of  neurocirculatory  response.  In  anemia, 
chlorosis  and  digestive  disorders  the  pack  can  he  used,  hut  it  is  better 
to  educate  these  cases  to  its  use  hy  a  preliminary  training  with  the  wet 
sheet.  The  wet  pack  should  be  followed  by  some  cold  application — 
sheet  bath,  half  bath,  cold  ablution,  rain,  jet,  etc. — to  restore  tone  to 
the  cutaneous  blood-vessels,  and  a  proper  selection  can  be  made  to 
meet  the  patient's  needs  and  conditions. 

The  only  contraindications  to  the  use  of  the  pack  are  great  feeble- 
ness, a  very  weak  heart,  vascular  disease  and  some  skin  diseases. 

The  Half  Wet  Pack. 

The  half  wet  pack  is  a  very  useful  procedure,  especially  where 
abdominal  and  pelvic  conditions  are  to  be  met.  It  is  easily  applied  as 
follows : 

Fold  a  blanket  so  that  it  will  extend  from  the  axilla  to  ten  to 
twelve  inches  beyond  the  feet.  Place  the  blanket  across  the  cot  or  bed; 
fold  a  coarse  linen  sheet  to  come  within  two  inches  of  the  upper  and 
lower  ends  of  the  blanket.  Now  wring  the  sheet  out  of  water  at  from 
50°  to  70°  F.,  spread  same  on  the  blanket  (see  cut)  and  have  the 
patient  lie  down  on  it  so  that  the  upper  edge  of  the  blanket 
reaches  the  axilla.  Rapidly  draw  the  sheet  around  the  trunk,  tucking 
it  well  under  the  body  on  either  side  and  enveloping  the  legs  as  in  the 
full  pack  (see  cut).  Likewise  apply  the  blanket,  being  sure  to  draw 
the  edges  very  tight.  Cover  the  patient  with  bed  clothing  and  apply 
a  cold  wet  turban,  cold  water  cap,  or  cold  circular  compress  to  the 
head  or  neck  (see  cut). 

The  immediate  and  secondary  effects  are  similar  to  those  of  the 
full  pack,  but  less  in  degree.  Patients  react  much  more  quickly  than 
in  the  full  pack,  and  it  can  therefore  be  more  extensively  and  fre- 
quently used.  Its  physiological  action  is  similar  and  need  not  be 
repeated. 

Hot  Blanket  Pack. 

In  some  instances,  where  we  wish  to  apply  great  heat  to  the  entire 
body  in  the  form  of  a  pack,  we  may  substitute  for  the  sheet  a  blanket 
wrung  out  of  very  hot  water,  120°  to  130°  F.  (see  cut)..  The 
method  of  its  application  is  then  the  same  in  every  particular  as  the 
full  wet  pack,  the  aim  being  in  this  instance  to  retain  all  the  heat 
possible.  If  desired,  the  blankets  may  be  finally  covered  with  a  rubber 
sheet. 

The  Dry  Full  Pack. 

This  simple  procedure  is  comparatively  little  used,  owing  to  more 
valuable  methods  of  securing  the  same  results.  The  aim  in  the  dry 
pack  is  to  produce  sweating,  the  excitation  of  perspiration  being 
brought  about  by  heat  retention,  the  rough  and  irritating  surfaces  of 


140  PRACTICAL  HYDROTHERAPY. 

the  blanket  serving  to  stimulate  cutaneous  hyperemia.  This  pack  may 
be  applied  upon  a  bed  or  couch.  Two  blankets  are  first  warmed  and 
then  spread  upon  a  couch  or  bed,  and  upon  these  the  patient  reclines 
entirely  nude.  The  upper  left  edge  of  the  inner  blanket  is  now 
carried  under  the  left  arm,  over  the  body  and  tucked  under  the  right 
side;  then  the  right  side  is  carried  over  the  right  arm,  over  the  body 
and  over  the  left  arm  and  tucked  under  the  left  side.  The  left  lower 
edge  is  carried  over  the  patient's  left  leg  and  under  the  right  leg.  The 
right  edge  is  then  carried  over  both  legs  and  tightly  and  snugly  tucked 
under  the  legs.  The  bottom  is  closely  folded  from  above  downward 
and  placed  under  the  feet,  where  it  is  held  by  their  weight.  The 
second  blanket  is  similarly  applied.  A  towel  is  tucked  around  the 
neck  to  secure  comfort.  The  patient  now  resembles  a  mummy.  Addi- 
tional blankets  should  be  used  to  cover  him  thoroughly.  Care  must 
be  exercised  to  prevent  "air  currents,"  and  the  patient  should  be 
instructed  to  be  still.  If  the  blanket  is  pulled  very  tight  comfort  and 
freedom  from  muscular  fatigue  will  be  secured;  if  loose  it  is  apt  to 
make  patients  nervous  and  produce  tickling.  A  hot-water  bottle  to 
the  feet  hastens  perspiration.  A  cold  cephalic  compress  prevents 
retrostasis.     The  blankets  must  be  aired  and  kept  clean  and  dry. 

Physiological  Action  of  the  Dry  Pack. — The  first  effect  of  the 
blanket,  if  tightly  and  correctly  applied,  is  to  produce  muscular  relax- 
ation. The  woolen  strands  irritate  the  skin.  The  blood-vessels  of  the 
skin  dilate  and  the  body  is  warmed.  The  skin  becomes  reddened,  and 
as  heat  elimination  is  prevented  it  accumulates  on  the  surface  and 
shortly  thereafter  perspiration  commences.  As  in  other  heating  pro- 
cedures, the  pulse  at  this  stage  is  accelerated,  the  head  is  apt  to  feel 
full  and  a  sense  of  discomfort  is  felt.  With  the  outbreak  of  per- 
spiration the  pulse  becomes  slower  and  the  patient  more  comfortable. 
The  time  necessary  for  these  phenomena  varies,  but  is  usually  un- 
comfortably long  to  the  patient.  The  duration  may  be  lessened  by  a 
preliminary  heating,  by  hot-water  bottles  around  and  under  the  extra 
covering.  The  dry  pack  is  simply  a  preparatory  procedure,  and  when 
used  alone  has  little,  if  any,  therapeutic  indication.  It  may  prove 
useful  in  promoting  reaction  in  those  who  fail  to  respond  to  active 
cold  methods. 

In  connection  with  the  electric  light  bath  and  fomentation,  in 
sciatica,  it  has  proved  in  my  hands  of  some  value  as  a  protective 
during  the  application  of  the  fomentation.  It  should  always  be 
borne  in  mind  that  in  this,  as  in  all  procedures  having  for  their  object 
the  heating  of  the  surface  and  the  production  of  perspiration,  it 
must  be  followed  by  a  heat-depriving  measure,  adapted  to  the  heat 
accumulation  and  the  patient's  reactive  power.  A  sensitive  vaso- 
motor system,  cerebral  determination,  in  cutaneous  hyperesthesias,  in 
skin  eruptions  and  in  the  very  nervous,  it  should  not  be  used. 


i  l\\ 


) 


r--*-^ 


Plate  82— Foot  Bath. 


THE  TECHNIQUE  OE  HYDROTHERAPY.  141 

The  half  dry  pack  is  limited  to  the  trunk  in  its  use,  and  extends 
from  the  axilla  to  the  hips,  the  extremities  being  free.  It  is  applied 
snugly  to  this  region,  and  is  employed  for  gastrointestinal  disorders. 
It  has  little  value. 

Of  all  the  measures  used  to  prepare  patients  for  hydriatics,  the 
dry  pack  possesses  the  least  value,  and  should  not  be  used  when 
there  are  other  and  more  satisfactory  methods  at  hand.  It  is  slow, 
disagreeable  and  inefficient. 

Local  Baths. 

The  hydriatist  is  apt  to  describe  in  much  detail  the  many  local 
baths,  hot,  cold  and  neutral,  of  which  we  may  mention  the  hand,  arm, 
elbow,  leg,  foot,  etc.,  as  the  principal  ones.  Their  effects  are  similar, 
and  differences  that  exist  are  due  to  anatomical  rather  than  physio- 
logical changes,  for  they  are  in  their  finality  limited  to  local  and  de- 
rivative action.  As  a  type  of  this  class  we  shall  only  describe  the  most 
frequently  used  one,  viz.,  the  hot  and  cold  foot-bath. 

Foot-Baths. — The  tub  may  be  of  wood,  metal  or  porcelain,  prefer- 
ably of  the  latter.  It  should  be  of  sufficient  size  to  admit  feet  of  good- 
sized  caliber  without  cramping,  and  yet  at  the  same  time  permit  some 
freedom  of  movement.  In  the  arrangement  of  this  tub,  modern  at- 
tachments must  be  used  that  will  permit  of  the  entrance  of  water 
from  below,  either  between  the  feet  or  from  the  end  toward  which 
the  toes  are  turned. 

In  the  use  of  the  hot  foot-bath,  the  tub  is  filled  to  the  depth  of 
four  to  five  inches,  or,  if  further  derivative  influences  are  sought,  it 
can  be  filled  so  as  to  embrace  the  leg.  The  initial  temperature  should 
be  about  104°,  this  being  rapidly  raised  to  the  point  of  tolerance,  so 
that  by  the  end  of  two  or  three  minutes  the  water  has  become  as  hot 
as  115°  to  120°  F.  The  duration  ranges  from  five  to  thirty  minutes. 
Its  action  may  be  slightly  enhanced  by  moving  the  feet  about  slowly. 
As  the  water  cools,  more  should  be  added  to  maintain  the  tempera- 
ture. It  is  desirable  to  retain  the  blood  in  the  parts  and  secure  tonic 
dilatation ;  for  this  reason  the  foot-bath  should  be  followed  by  a  very 
brief  cold  application,  such  as  a  quick  immersion  in  cold  water,  a  pail 
dash  or  a  cold  spray,  thus  securing  reaction. 

The  local  and  general  effects  are  those  of  the  hot  full  bath,  limited 
to  the  pedal  extremities,  which  effects  have  been  fully  described. 
The  hot  foot-bath  is  a  much-used  family  remedy  in  the  treatment  of 
incipient  inflammatory  troubles  of  the  respiratory  mucous  membrane. 
It  is  also  a  derivative  of  no  mean  value  in  removing  blood  from  the 
pelvic,  rectal  and  lower  abdominal  regions,  stimulating  the  involun- 
tary muscular  fibers  of  these  organs  as  well.  In  painful  conditions 
of  the  feet,  sprains,  bruises,  myalgia  and  neuralgia,  these  baths  afford 
temporary  and  sometimes  permanent  relief  where  they  are  used  fre- 


142  PRACTICAL  HYDROTHERAPY. 

quently.  The  so-called  "fullness  of  the  head"  from  which  neuras- 
thenics suffer  is  temporarily  relieved.  In  certain  surgical  injuries, 
in  ulcers,  felons,  burns,  etc.,  the  foot-bath,  at  moderate  or  neutral 
temperatures,  fills  a  useful  niche. 

The  cold  foot-bath  is  applied  by  means  of  the  same  tub  at  tem- 
atures  ranging  from  50°  to  60°  F.,  its  duration  ranging  from  one  to 
five  minutes.  It  is  much  less  frequently  used  than  the  hot  foot-bath, 
although  it  is  not  an  infrequent  application.  It  will  be  found  that  the 
effect  of  the  bath  is  greatly  enhanced  by  a  short  primary  immersion 
of  the  feet  in  warm  water.  The  patient  should  be  instructed  while 
the  feet  remain  in  the  bath  to  chafe  them  constantly  by  rubbing  one 
foot  against  the  other. 

The  physiological  action  of  the  cold  foot-bath  is  in  general  that 
of  the  cold  full  bath  already  described.  Its  revulsive  and  reflex  ef- 
fects are  more  extensive  than  those  of  the  hot  foot-bath.  The  action 
of  the  cold  foot-bath  is  locally  tonic,  acting  with  especial  selection  upon 
the  pelvic  and  lower  abdominal  viscera.  By  reflex  action  it  causes 
contraction  of  the  unstriped  muscular  fibers  of  the  various  organs  and 
blood-vessels  contained  in  these  areas,  and  especially  the  muscular 
tissue  of  the  uterus  and  bladder.  Where  the  rubbing  of  the  feet  is 
maintained  constantly  during  its  application,  it  acts  as  a  derivative 
upon  the  cerebral  circulation,  lessening  the  quantity  of  blood  therein. 
This  is  equally  true  of  local  applications  made  to  the  hand  and  wrist, 
it  being  an  interesting  fact  that  the  immersion  of  the  hands  in  cold 
water  will  stop  nose  bleed,  and  during  the  heat  of  summer  will  do 
much  to  lessen  the  quantity  of  blood  in  the  brain,  as  well  as  reduce 
temperature.  It  has  been  a  .frequent  observation  of  the  author's  that 
the  sudden  application  of  cold  to  the  feet  will  promptly  cause  an  evac- 
uation of  the  bladder,  a  fact  that  has  been  utilized  by  him  when  un- 
able to  secure  a  catheter.  The  very  cold  foot-bath  of  short  duration 
is  a  most  excellent  measure  for  relieving  persistent  cold  and  sweating 
feet,  in  which  cases  it  should  be  administered  at  a  temperature  of  503 
F.  for  one  minute.  In  cases  of  insomnia,  where  they  have  been  of 
short  duration,  and  largely  brought  about  by  deficient  circulation, 
this  bath  may  be  of  some  help,  but  my  experience  has  been  that  such 
cases  demand  more  extensive  general  procedures.  One  should  be 
careful  to  avoid  administering  the  cold  foot-bath  when  any  inflam- 
matory trouble  of  the  pelvis,  bladder  or  rectum  exists.  It  should 
be.  remarked  that  localized  conditions,  such  as  chronic  rheumatic 
troubles,  neuralgia  and  some  cutaneous  diseases,  forbid  the  use  of 
this  bath. 

It  is  interesting  here  to  note  that  one  of  the  most  popular  "fads" 
of  recent  years  has  had  to  do  with  the  local  application  of  wet  cold 
to  the  feet  and  ankles.  I  refer  to  the  so-called.  "Father  Kneipp  cure." 
This  method  came  somewhat  into  vogue  with  certain  fashionable,  in- 


Plate  83— Sitz  or  Hip  Bath  Tubs. 


-H 


Plate  84 — Sitz   or   Hip   Bath. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  143 

active  and  over-fed  people,  who  were  prone  to  attribute  the  good  re- 
sults obtained  to  walking  through  the  grass  while  still  wet  with  the 
morning  dew.  They  seemed  to  ignore  the  fact  that  they  were  upon 
reduced  rations,  coarse  food,  and  taking  active  exercise  in  the  open 
air.  They  doubtless  derived  some  benefit  from  the  application  of  cold 
to  the  pedal  extremities.  Like  most  fads,  it  had  its  day,  being  literally 
"run  into  the  ground." 

The  Sitz  or  Hip  Bath. — This  is  a  very  valuable  local  hydriatic 
measure  that  has  been  in  use  for  a  long  number  of  years.  The  sitz  bath 
may  be  administered  by  means  of  a  sitz  bath-tub  made  of  metal  or  por- 
celain, the  latter,  of  course,  being  preferable.  The  sitz  tubs  upon  the 
market  at  the  present  time  are  all  that  could  be  desired  by  those  contem- 
plating their  purchase.  It  should  be  of  such  size  that  the  patient  can 
comfortably  sit  in  the  tub  with  the  feet  hanging  out,  and  be  provided 
with  modern  arrangements  for  the  introduction  of  hot  and  cold  water 
from  the  bottom.  The  rim  should  be  broad  enough  so  that  there  will 
be  no  necessity  to  flex  the  limbs  and  compress  the  popliteal  space,  for 
where  this  is  done  the  circulation  in  the  lower  limbs  is  interfered  with 
materially.  Where  the  individual  is  short  of  limb  it  makes  the  bath 
more  comfortable  to  have  the  feet  supported.  The  tub  should  be 
rilled  with  water  of  the  proper  temperature  desired  for  the  applica- 
tion to  such  a  depth  as  will  reach  the  level  of  the  patient's  umbilicus. 
During  the  use  of  this  bath  the  upper  trunk  should  be  protected  by 
some  covering,  either  in  the  shape  of  a  Turkish  sheet  or  undervest,  to 
prevent  chilling.  The  patient  must  semi-recline  with  the  back  resting 
upon  the  back  of  the  sitz  tub,  the  limbs  separated  so  that  the  lumbar, 
lower  abdominal  regions,  outer  and  inner  surface  of  the  thighs,  the 
perineum  and  external  genitals  are  brought  in  contact  with  the  water. 
When  the  cold  sitz  is  employed  the  head  should  be  covered  with  a  cold 
towel  or  wet  turban,  and  this  may  likewise  be  used  during  the  hot 
sitz,  although  it  is  usually  not  required. 

The  Cold  Sitz  Bath. — This  bath  is  not  only  a  valuable  local  appli- 
cation, but  influences  more  or  less  all  bodily  functions.  During  its 
administration  the  attendant  and  patient  should  rub  the  external  sur- 
faces in  contact  with  the  water,  in  order  that  the  frictions  may 
stimulate  the  cutaneous  blood-vessels  to  dilate.  This  bath  is  usually 
administered  at  temperatures  from  80°  to  50°  F.  for  five  to  fifteen 
minutes,  according  to  the  effect  desired.  It  causes  a  contraction  of 
the  cutaneous  blood-vessels  of  the  area  covered  by  the  water,  and 
from  which  the  column  of  blood  is  driven  inward ;  this  effect  seems 
especially  felt  in  the  head,  and  may  on  certain  occasions,  as  the  author 
has  demonstrated  on  his  own  person,  be  used  to  increase  cerebral 
activity.  This  in  practice  calls  for  a  cold  turban  or  ice-cap  to  prevent 
the  unpleasant  feeling  of  fullness.  With  the  application  of  friction 
the  blood-vessels  begin  to  dilate  and  a  slight  rosy  hue  is  produced  in 


144  PRACTICAL  HYDROTHERAPY. 

the  skin.  With  the  dilatation  of  the  peripheral  blood-vessels  under 
friction  the  column  of  blood  is  again  directed  toward  the  periphery 
and  maintained  there,  and  this  maintenance  of  the  blood  in  the  skin 
acts  as  a  tonic,  and  is  in  no  sense  a  vascular  paresis.  The  heart's  action 
becomes  stronger  and  better,  the  pulse  slower,  increased  in  volume 
and  arterial  tension  raised.  Temperature  is  reduced  in  the  parts 
immersed,  which  will  be  compensated  if  the  bath  is  of  moderate 
duration.  When  reaction  takes  place,  local  temperature  is  elevated. 
If  long  continued  a  systemic  reduction  may  take  place. 

The  influence  of  this  bath  is  probably  greatest  upon  the  nervous 
system.  The  thermic  impression  rising  from  the  impact  of  cold  upon 
the  surface  is  conveyed  reflexly  to  the  anatomically  related  areas  in 
the  pelvis,  lower  abdominal  regions,  and  reflexly  upon  the  whole  of 
the  spinal,  central  and  sympathetic  nervous  systems.  It  stimulates 
the  peripheral  nerve  endings,  increasing  their  dynamic  influence  in  no 
small  way.  Upon  the  spinal  and  sympathetic  centers  that  preside  over 
the  genito-urinary  apparatus  this  bath  has  a  wide  influence,  brief  appli- 
cations toning  and  stimulating  these  structures.  Owing  to  the  inti- 
mately correlated  relations  between  the  abdominal  viscera  and  the  skin 
of  the  lower  abdomen  and  hips,  we  may  by  this  bath  so  increase  and  im- 
prove the  intricate  chemistry  of  digestion  and  assimilation  as  to  improve 
general  metabolism.  It  is  a  clinically  observed  fact  that  functional 
activity  in  these  organs  is  much  enhanced.  Upon  the  muscular  struc- 
tures related  to  the  bath,  directly  and  reflexly,  the  cold  sitz  acts  as  a 
tonic,  improving  the  power  of  contraction  in  the  various  viscera  of  the 
pelvic  and  lower  abdominal  regions.  This  is  especially  true  of  the 
functions  of  defecation  and  urination,  upon  which  these  baths  possess 
potent  power.  The  muscles  of  the  abdominal  wall  and  muscular 
ligamentous  structures  supporting  the  pelvic  viscera  are  toned  and 
strengthened  by  this  application.  It  increases  the  elimination  of  waste 
products  through  the  kidney  and  stimulates  the  outflow  of  bile,  prob- 
ably because  the  portal  circulation  is  much  increased  and  its  tension 
raised. 

The  therapeutic  application  of  the  cold  sitz  bath  is  extensive,  it 
being  a  powerful  tonic  to  local  functions.  Where  the  muscular  struc- 
tures of  the  urinary  bladder  are  weak  or  paralytic  in  adults,  and 
especially  children  who  suffer  from  nocturnal  incontinence  of  urine, 
the  brief  cold  sitz  is  indicated.  In  weakened  sexual  power,  with  general 
loss  of  tone,  in  spermatorrhea,  prostatorrhea.  chronic  congestions  of 
the  vesicles  and  prostate,  this  bath  at  60°  to  70°  F.  for  ten  to  fifteen 
minutes  will  prove  of  signal  benefit.  In  diseases  of  the  pelvic  organs 
in  the  female,  where  they  are  dependent  upon  low-grade  chronic  in- 
flammations, relaxation,  lack  of  tone,  congestion,  etc..  where  no  pus 
is  present,  this  procedure  will  prove  tonic  and  stimulant  in  their  re- 
lief. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  145 

In  profuse  menstruation  Baruchs  says  that  in  those  cases  which 
"drag  on  from  month  to  month,  the  patient  exhausted  and  anemic, 
and  thus  establish  a  vicious  circle  which  maintains  the  drain,  when 
curetting  has  failed  or  is  not  indicated,  the  flow  being  maintained  by  a 
feeble  local  and  general  circulation,  hip  baths  of  five  to  eight  minutes, 
in  water  at  85°  F.,  with  constant  friction,  followed  by  affusions  or 
preferably  by  the  circular  bath  and  then  douches  at  the  same  or  a 
lower  temperature,  far  excel  all  medicinal  agents.  It  is  the  author's 
custom  in  such  cases  to  order  the  hip  baths  on  the  fifth  day  of  the 
menstruation,  when  the  latter  arrives  at  a  distinct  period,  and  to  con- 
tinue it  daily  until  the  flow  has  ceased.  If  no  distinct  period  exists, 
the  hip  bath  should  be  ordered  after  the  flow  has  become  profuse,  and 
it  should  be  continued  until  the  flow  ceases.  Not  only  will  the  drain 
be  thus  checked,  but  the  tonic  effect  of  such  a  bath  will  counteract 
the  depreciated  systemic  condition  and  restore  the  patient's  health  and 
spirits.  Most  women  object  strenuously  to  the  cold  hip  bath  in 
menstrual  disorders.  It  is  therefore  wise  to  forestall  their  fears  by 
reassuring  them  of  the  necessity  and  great  value  of  brief  hip  baths  in 
these  conditions."  In  diarrhea,  dysentery  and  all  inflammatory  dis- 
eases of  the  small  intestines,  colon  and  rectum,  the  author  has  found 
the  method  of  Winternitz  the  most  satisfactory.  The  patient  is  given 
a  dripping  sheet,  as  heretofore  described,  followed  by  a  cold  sitz  bath 
for  ten  to  fifteen  minutes,  commencing  with  a  temperature  of  85°  F. 
and  gradually  reduced  to  60°  F.  Some  cases  do  better  at  70°  rather 
than  60°  F.  The  patient  and  attendant  should  be  made  to  persist- 
ently rub  the  abdominal  walls  during  the  administration  of  the  bath. 
Its  action  is  to  stimulate  the  sympathetic  nerves,  diminish  peristaltic 
action,  lessen  secretion  and  contract  the  intestinal  blood-vessels.  In 
jaundice,  where  the  duct  is  open,  in  those  who  suffer  from  chronic 
deficiency  of  biliary  secretion,  the  bile  may  be  augmented  through  the 
use  of  this  bath.  Because  of  its  muscular  effects  the  cold  sitz  (50° 
to  60°  F.)  for  five  to  seven  minutes  will  overcome  constipation. 
Where  there  is  a  therapeutic  indication  for  an  increased  quantity  of 
blood  to  circulate  in  the  brain  we  have  in  the  cold  sitz  bath  a  method 
of  driving  the  blood  to  this  structure. 

The  cold  sitz  bath  is  contraindicated  in  all  irritable  and  painful 
conditions  of  the  abdominal  and  pelvic  organs ;  in  acute  inflammatory 
states  such  as  cystitis,  ovaritis,  cellulitis,  etc. ;  in  pus  formation ;  in  all 
forms  of  muscular  spasm ;  in  profuse  uterine  hemorrhage,  and  in 
acute  inflammations  of  the  rectum. 

Certain  modifications  hardly  worthy  of  a  distinct  consideration 
consist  in  the  employment  of  the  so-called  tepid  sitz  bath  (68°  to 
86°  F.)  for  twenty  to  thirty  minutes,  it  possessing  some  antiphlogistic 
power.      In    certain    painful    affections    of   the    pelvic   viscera,    lower 

8  Loc.   cit.,   p.   222. 


146  PRACTICAL  HYDROTHERAPY. 

abdominal  region  and  rectum  the  use  of  the  alternating  sitz  is  valuable. 
They  may  be  either  administered  as  a  hot  sitz  (110°  F.)  for  ten 
minutes,  followed  by  a  short  dip  in  a  cold  bath  (60°  to  70°  F.)  for  a 
few  seconds,  or  we  may  reverse  the  procedure  by  a  short  dip  in  a 
cold  sitz  followed  by  a  five  minutes'  immersion  in  a  hot  sitz.  The 
indication  for  the  use  of  these  measures  will  be  found  to  be  rare. 

The  Hot  Sitz  Bath. — This  is  administered  at  temperatures  ranging 
from  104c  to  115°  F.,  somewhat  higher  in  special  cases.  Its  duration 
ranges  from  three  to  fifteen  minutes,  a  fair  average  being  about  ten 
minutes.  Most  patients  object  to  the  immediate  immersion  of  even  a 
portion  of  the  body  in  water  at  a  temperature  of  104°  F.  or  higher, 
and  for  this  reason  it  is  well  to  commence  the  use  of  the  bath  with  a 
temperature  of  100°  F.,  rapidly  adding  hot  water  until  the  maximum 
temperature  is  reached.  This  will  be  an  easy  matter  in  those  modern 
sitz  tubs  where  the  water  enters  the  tub  from  the  bottom.  In  the  use 
of  the  hot  sitz  bath  additional  derivative  effects  may  be  obtained  by 
the  use  of  the  hot  foot-bath. 

The  physiological  action  of  the  hot  sitz  bath  is  that  of  a  localized 
hot  bath.  The  hot  water  causes  an  atonic  dilatation  in  the  cutaneous 
blood-vessels,  especially  those  of  the  external  iliac  artery,  brought 
about  both  by  its  direct  and  reflex  action,  the  skin  becoming  reddened 
and  intensely  congested  as  paralysis  of  the  vasomotor  constrictors 
takes  place.  With  this  intense  dilatation  the  quantity  of  blood  in  the 
pelvis  is  largely  increased,  the  major  portion  being  drawn  from  the 
area  of  the  portal,  although  quite  a  good  deal  of  blood  comes  from  the 
general  circulation.  There  is  a  noticeable  increase  in  the  pulse-rate 
and  a  slight  diminution  in  blood  pressure  at  this  time.  Temperature 
is  elevated,  coincident  with  which  we  find  general  perspiration,  with 
increased  local  action  of  the  glandular  structures  of  the  skin  in  con- 
tact with  the  water.  Metabolism  is  enhanced,  nitrogenized  products 
being  more  rapidly  oxidized  into  urea.  The  glandular  structures  of 
the  pelvis  are  stimulated  and  discharge  more  freely  their  mucus. 
Upon  muscular  tissue  brought  under  its  influence  it  has  a  decided 
quieting,  relaxing  and  antispasmodic  effect.  Upon  the  nervous 
mechanism  anatomically  related,  it  is  a  sedative  of  high  value,  re- 
ducing the  number  of  impressions  that  arise  from  the  periphery, 
owing  to  its  heat  and  the  more  succulent  and  sedative  condition  of  the 
cutaneous  nerves.  Pain  and  spasm  are  diminished  and  relief  obtained. 
Its  physiological  action  points  clearly  its  use. 

The  therapeutic  application  of  the  sitz  bath  has  been  known  for 
many  years,  and  is  in  many  households  a  family  remedy.  It  has 
probably  been  more  frequently  used  and  proven  of  greater  service 
than  any  other  hydriatic  application  in  the  restoration  of  painful  and 
suppressed  menstruation  from  whatever  cause.  In  this  condition  it 
not  only  checks  the  pain  and  spasm  that  is  present,  but  by  materially 


Plate  85— Half  Bath. 


Plate  86 — Affusion  to  Back  and  Spine. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  147 

increasing  the  quantity  of  blood  in  the  pelvis  favors  bleeding,  and 
therefore  immediate  relict.  In  its  use  care  should  be  taken  to  prevent 
chilling  afterward,  and  for  this  reason  it  is  best  administered  just 
before  bed-time,  its  action  being  maintained  upon  return  to  bed  by 
the  use  of  the  In  it-water  bottle,  etc.  In  the  painful  tenesmus  of 
vesica]  catarrh  of  whatever  origin,  it  is  a  remedy  that  will  at  once 
bring  relief  to  the  sufferer.  Where  there  is  retention  of  urine  and 
inability  to  introduce  the  catheter  this  can  frequently  be  accomplished 
and  relief  gained  by  introducing  the  instrument  during  the  application 
of  the  sitz  hath;  the  water  should  be  as  hot  as  can  be  borne.  In  anal 
tenesmus,  in  inflamed  hemorrhoids,  in  vaginismus,  in  various  neural- 
gias of  the  ovaries  and  external  genitalia,  the  hot  sitz  bath  is  an 
excellent  analgesic  measure.  Where  these  latter  conditions  do  not 
depend  upon  inflammatory  conditions  a  very  brief  application  of  cold, 
such  as  an  affusion,  will  enhance  and  lengthen  the  influence  of  the 
hath.  In  all  forms  of  pelvic  trouble  where  we  desire  a  relaxing,  anti- 
spasmodic, sedative  and  anodyne  influence,  the  hot  sitz  bath  will  meet 
the  indications. 

The  Half  Bath. 

This  bath  is  administered  in  an  ordinary  bath-tub,  which  should 
be  of  sufficient  length  to  permit  of  the  patient's  sitting  comfortably 
with  the  limbs  extended.  The  best  tub  is  a  porcelain-lined  one,  and 
should,  in  use.  be  filled  with  water  that  reaches  to  the  level  of  the 
umbilicus.  The  temperature  at  which  it  is  usually  administered  ranges 
from  85°  to  50°  F.,  although  the  latter  is  very  rarely  used.  A  fair 
average  is  from  75°  to  65°  F.  Always  commence  with  85°  or  even 
90°  F.  and  reduce  the  temperature  two  or  three  degrees  daily  until 
the  desire!  point  is  reached.  The  tub  is  first  filled  to  the  proper  depth 
and  an  ice-helmet  placed  on  the  patient's  head,  after  which  he  steps 
into  the  tub  and  sits  with  the  limbs  extended,  the  attendant  standing 
on  the  patient's  right  side,  leaning  over  to  apply  the  friction.  During 
the  bath  the  patient  dashes  water  against  the  chest  and  arms,  applying 
friction,  while  the  attendant  either  dashes  water  from  the  tub  against 
the  back  and  sides  with  one  hand  while  he  applies  friction  with  the 
other,  or  ('ashes  water  upon  the  patient  from  pails  that  stand  beside 
the  bath-tub.  The  author's  experience  has  led  him  to  use  the  fol- 
lowing method,  which  he  believes  is  superior  to  the  usual  one  of  giv- 
ing the  half  bath:  As  soon  as  the  patient  seats  himself  in  the  tub,  the 
attendant  at  once  commences  to  chafe  the  surfaces  of  the  lower  limbs, 
spending  approximately  one-half  minute  upon  each  limb,  while  the 
patient  applies  friction  to  the  lower  abdominal  wall  and  buttocks. 
The  attendant  then  moves  to  the  back,  and  with  the  left  hand  dashes 
water  from  the  tub  upon  the  back  while  he  applies  friction  vigorously 
with  the  right  hand,  the  patient  in  the  meantime  splashing  water  upon 


148  PRACTICAL  HYDROTHERAPY. 

the  chest  and  arms,  rubbing  them  as  vigorously  as  he  can.  This  should 
occupy  about  two  minutes ;  the  time  may  be  lengthened  proportionately 
to  the  duration  of  the  bath. 

The  duration  of  the  bath  should  range  from  two  to  rive  minutes, 
at  the  end  of  which  time  the  patient  receives  an  affusion,  over  the 
back  and  shoulders,  of  water  several  degrees  colder  than  that  in  the 
tub.  He  is  then  lifted  or  steps  out,  and  is  rapidly  rubbed  down  with 
Turkish  towels  until  dry  and  good  reaction  obtained.  Exercise  may 
then  be  taken  if  indicated. 

The  Physiological  Action  of  the  Half  Bath. — Thi?  powerful  tonic 
and  stimulative  measure  more  nearly  resembles  the  douche  than  any 
method  that  does  not  employ  apparatus.  In  general  practice  it  may 
be  used  in  place  of  the  douche,  and  should  take  precedence  over  the 
much-abused  "plunge."  The  repeated  splashing  of  the  water  upon 
the  skin  surface,  and  the  friction,  influence  the  vascular  state  pro- 
foundly. AYith  the  first  contact  there  will  be  a  contraction  of  the 
surface  tissues,  paleness  and  lessened  blood-supply.  There  is  a  gasp- 
ing respiration,  sense  of  constriction  and  discomfort.  As  soon  as 
the  friction  is  applied  the  column  of  blood  comes  to  the  surface  and 
fills  the  tonically  dilated  blood-vessels,  which  further  dilate  when 
reaction  takes  place.  There  is  practically  no  heat  abstraction,  owing 
to  the  brief  duration  of  the  bath.  Respiration  is  deepened,  with  better 
exchange  of  gases ;  all  phases  of  metabolism  enhanced,  and  muscular 
power  increased.  It  is  a  powerful  tonic  stimulant  to  the  nervous  sys- 
tem through  the  thermo-mechanical  impressions  made  by  the  cold  water 
and  friction,  and  especially  influences  the  functions  of  the  spinal  cord. 
For  greater  detail  of  these  effects,  the  reader  should  peruse  the  sec- 
tion in  which  is  detailed  the  physiological  action  of  the  douche. 

The  therapeutic  application  of  this  bath  is  wide.  As  a  substitute 
in  private  practice  for  the  douche,  it  becomes  useful  in  all  those 
chronic  diseases  in  which  circulation,  metabolism  and  nerve  force 
need  regeneration.  The  author  has  found  this  bath  of  unusual  value 
in  chronic  organic  diseases  of  the  spinal  cord,  especially  in  cases  of 
locomotor  ataxia,  chronic  spinal  meningitis,  chronic  myelitis  and  sim- 
ilar affections.  In  these  diseases  it  is  customary  to  use  the  half  bath 
for  two  to  five  minutes,  commencing  at  a  temperature  of  80°  to  85° 
F.,  gradually  reducing  the.  temperature  of  each  succeeding  bath  until 
70°  or  65°  F.  is  reached.  The  friction  should  be  well  applied,  strong 
enough  to  bring  about  a  reaction  in  the  bath,  and  sufficient  to  make 
the  patient  feel  fairly  comfortable.  In  the  diseases  mentioned,  pain  is 
usually  a  contraindication  for  its  use,  but  I  have  seen  good  results 
follow  these  baths  even  when  marked  lancinating  pains  were  present. 
The  author  has  used  with  the  half  bath  pine  extract,  mustard  and  other 
stimulating  measures,  but  has  never  found  them  of  any  additional 
value,  and  now  rarely  employs  them.      Strasser  has   found  the  half 


THE  TECHNIQUE  OF  HYDROTHERAPY.  149 

bath,  at  65°  to  70°  F.,  for  six,  gradually  increased  to  fifteen  minutes, 
of  service  in  the  treatment  of  febrile  and  infectious  diseases,  for 
where  it  is  sufficiently  prolonged  (fifteen  minutes)  and  friction  con- 
tinued, it  abstracts  heat,  strengthens  the  heart  and  overcomes  circu- 
latory weakness,  arouses  and  tones  the  nervous  system,  lessens  mus- 
cular weakness,  favors  metabolic  changes  and  provokes  diuresis.  The 
author  prefers  either  the  sponge  and  compress  or  the  full  bath.  In 
respiratory  diseases,  in  hypostatic  congestion,  in  bronchitis  and  other 
affections,  the  patient  should  be  placed  in  a  half  bath  at  90°  F.,  and 
held  in  a  semi-recumbent  position  by  one  nurse  while  another  bathes 
the  upper  part  of  the  body,  and  especially  the  chest,  with  water  at 
50°  to  60°  F.,  or  gives  an  affusion  to  the  chest  (see  cut)  at  the  same 
temperature.  It  will  arouse,  stimulate,  and  relieve  even  desperate 
cases.  In  anemia,  chlorosis  and  other  depraved  blood  states,  it  not 
alone  increases  hemoglobin  and  corpuscular  richness,  but  causes  the 
system  to  rapidly  utilize  iron,  which  had  before  seemingly  been  of 
little  avail.  It  may  be  employed  after  the  use  of  heating  and  sweating 
procedures  in  a  similar  manner  to  the  douche.  For  this  purpose  it 
is  popular  with  foreign  hydriatists,  although  in  this  country  the 
douche  is  much  preferred.  In  neurasthenia,  in  the  functional  neuroses 
and  psychoses,  in  the  gastric  disturbances,  constipation  and  auto- 
toxemia  accompanying  them,  the  half  bath  will  be  found  an  excel- 
lent measure. 

The  hot  half  bath  is  rarely  employed  by  the  author,  the  indications 
for  its  use  being  better  met  by  the  full  hot  bath  or  the  hot  sitz  bath. 
One  can  vary  the  hot  full  bath  by  making  it  at  first  a  hot  half  bath, 
if  it  is  so  desired. 

The  cold  half  bath  is  contraindicated  in  acute  inflammations  of  the 
abdomen  and  pelvis,  in  profuse  uterine  hemorrhage,  in  suppurative 
states  in  the  pelvis,  in  painful  nerve  lesions  of  the  lower  extremities, 
in  acute  inflammations  of  the  heart  muscles  and  its  membranes,  and 
in  acute  inflammations  and  congestions  of  the  central  nervous  system. 
It  must  be  used  with  care  and  judgment  in  thoracic  diseases. 


CHAPTER  X. 
THE  TECHNIQUE  OF  HYDROTHERAPY. 

(Continued.) 

The  Very  Hot  and  Hot  Bath. 

These  baths  may  be  administered  in  an  ordinary  porcelain-lined 
tub  of  considerable  breadth  and  fully  seven  feet  long,  in  which  the 
average  patient  can  recline  comfortably  and  yet  have  the  shoulders 
well  covered.  A  strap  across  the  "head"  of  the  tub  can  be  arranged 
to  support  the  patient's  head,  though  this  is  not  absolutely  necessary. 
The  water  should  enter  at  the  "foot"  of  the  tub  from  below,  which  is 
easily  accomplished  by  the  modern  faucet  arrangement.  The  tem- 
perature of  the  very  hot  bath  ranges  between  104°  and  110°  F.  for 
Europeans  and  130°  F.  for  the  Japanese;  the  hot  bath  ordinarily 
varies  from  100°  to  104°  F.  The  difference  of  action  physiologically 
between  very  hot  and  hot  temperatures  is  one  of  degree.  The  Jap- 
anese can  stand  temperatures  that  are  extremely  painful  to  Europeans, 
but,  as  they  have  become  habituated  to  these  temperatures  from  youth, 
it  is  not  surprising  that  they  excel  the  "white  man"  in  tliermic  capacity. 
There  is  a  popular  idea  prevailing  that  the  very  hot  bath  is  productive 
of  diminished  power  of  resistance,  but  this  is  disproved  by  the  daily 
labor,  capacity  for  endurance,  and  other  wonderful  traits  exhibited  by 
the  Japanese.  Too  high  a  tribute  cannot  be  paid  to  these  people  for 
their  intelligent  use  of  bathing  and  for  their  great  personal  cleanliness. 
The  bath  should  be  administered  as  follows :  The  patient's  face  and 
neck  having  been  bathed  in  cold  water,  with  cold  compress  or  ice- 
helmet  upon  the  head,  he  steps  into  the  tub  and  reclines  in  water  at 
100°  F.  After  the  first  momentary  discomfort,  the  water  should  be 
rapidly  raised  to  the  temperature  desired  by  the  addition  of  hotter  or 
very  hot  water.  The  duration  of  the  bath  ranges  from  two  to  ten 
minutes,  being  governed  by  the  patient's  condition  and  peculiarities. 
Friction  during  the  bath  in  certain  conditions  is  of  value,  aiding  circu- 
latory effects. 

Physiological  Action  of  the  Hot  Full  Bath. — The  first  impression 
of  very  hot  water  upon  the  body  surface  is  similar  to  that  of  cold, 
producing  shivering,  a  sensation  of  pain  and  transient  discomfort. 
This  effect  is  of  short  duration,  and  is  followed  by  relaxation  and  a 
sense  of  warmth.  Its  effects  upon  circulation  are  marked,  the  blood- 
vessels being  first  constricted  and  later  dilated — in  fact,  becoming 
(150) 


THE  TECHNIQUE  OF  HYDROTHERAPY.  151 

much  distended  with  blood.  The  heart's  action  is  increased,  the  pulse 
rapid  and  feebler  as  the  temperature  is  raised,  but  tone  is  not  alto- 
gether lost,  this  being  more  noticeable  after  the  bath  than  during  its 
administration.  The  skin  is  red,  owing  to  the  dilated  cutaneous  blood- 
vessels, the  increased  quantity  of  blood  called  to  the  surface  being 
fairly  proportional  to  the  temperature  of  the  bath.  The  internal  blood- 
vessels are  contracted  through  diminished  quantity  of  blood  and  from 
reflex  action. 

During  its  administration  vascular  tension  is  at  first  slightly  raised, 
but  is  lowered  immediately  after  reaction  in  and  following  the  bath. 
Respiration  is  quickened  and  its  depth  lessened ;  C02  elimination  in- 
creased but  oxygen  absorption  diminished.  The  temperature  of  the 
body  is  markedly  raised  by  heat  absorption  and  the  prevention  of  heat 
elimination.  The  increased  quantity  of  blood  in  the  peripheral  blood- 
vessels, unable  to  lose  its  heat,  returns  to  the  center  of  the  body  and 
raises  internal  temperature. 

Upon  tissue  change  its  action  is  spoliative,  tending  especially  to 
break  down  lowly  organized  and  inflammatory  deposits.  Upon  mus- 
cular tissue  it  is  a  powerful  relaxant,  relieving  spasm  and  pain.  It 
has  an  agreeable  and  soothing  influence  upon  overstrained  and  tired 
muscles,  which  is  believed  to  be  due  to  its  destroying  the  toxic  prod- 
ucts of  fatigue  by  increased  oxidation.  In  like  manner  it  acts  as  an 
el i in i nan t,  destroying  many  toxic  materials  in  the  blood  by  its  in- 
creased temperature  and  removing  them  from  the  body  by  subsequent 
diuresis.  Upon  the  nervous  system  its  action  is  primarily  that  of  a 
powerful  stimulant.  The  first  impression  is  of  discomfort  and  in  a 
certain  sense  pain,  but  this  is  shortly  followed  by  a  feeling  of  comfort, 
relief  from  pain,  and  general  relaxation.  The  thermic  impressions 
traveling  inward  from  the  periphery  set  up  reflex  influences,  especially 
of  a  vasomotor  nature,  with  a  resultant  vascular  dilatation.  The  brain 
and  cord  soon  become  anemic,  as  evidenced  by  a  slight  drowsiness, 
and,  as  shown  by  Schuller,  a  sense  of  cephalic  pressure  and  a  vertigo 
on  rising  from  the  bath. 

Prof.  Baelz,  of  Tokio,  has  made  accurate  observations  on  the  hot 
bath.  Residing  among  a  cleanly  people,  with  whom  hot  bathing  is  a 
daily  practice,  there  being  four  hundred  thousand  hot  baths  given 
daily  in  Tokio  alone,  he  had  exceptional  opportunities  for  studying  their 
effects.  The  temperature  adopted  by  the  Japanese  is  usually  about 
130°  F.,  while  Europeans  indulge  in  baths  of  104°  to  109°.  F.  The  head 
is  usually  first  bathed  in  hot  water  before  the  bath  is  entered,  in  order  to 
relax  and  dilate  the  cerebral  vessels,  and  thus  prevent  cerebral  anemia 
when  the  cutaneous  vessels  become  greatly  dilated.  This  is  also  aided 
by  the  sitting  posture  usually  assumed.  Palpitation,  oppression  and 
a  decided  sense  of  great  heat  are  regarded  as  a  signal  for  removal. 
The   first   effect   of   such   a   bath   is   usually   pallor   and   goose   skin, 


152  PRACTICAL  HYDROTHERAPY. 

lasting  a  few  seconds;  the  pulse  becomes  slower,  and  afterward  more 
rapid.  At  first  the  respiration  is  not  much  affected ;  later  it  becomes 
more  rapid  and  purely  thoracic.  The  temperature  of  the  body  rises 
slowly  to  104°  and  over,  this  effect  being  due  to  heat  retention  com- 
bined with  direct  absorption.  It  occurs  rapidly,  often  within  six  min- 
utes, but  it  returns  to  normal  in  half  an  hour  after  the  bath.  The 
arteries  become  relaxed,  the  temporal  artery  assumes  a  dendritic  form, 
as  in  arterio-sclerosis.  The  pulse  is  full ;  its  curve  is  high.  Prolonged 
stay  in  the  bath  produces  vertigo  and  nausea.  The  consumption  of 
albuminoids  is  not  increased  by  the  hot  bath.  On  leaving  the  bath 
abundant  perspiration  ensues.  The  Japanese  apply  cold  affusions  be- 
fore leaving  the  bath.  Many  suppose  that  colds  are  easily  taken  after 
hot  baths.  According  to  Baelz,  this  is  impossible.  While  a  warm 
bath  relaxes  the  vasoconstrictors,  and  thus  predisposes  to  cold,  the 
very  hot  bath  produces  a  paralysis  of  the  cutaneous  vessels,  which 
lasts  some  time  and  prevents  their  contraction  when  exposed  to  cold ; 
the  Japanese  often  run  naked  on  the  streets  after  their  hot  baths 
without  taking  cold.  Such  a  bath  produces  no  tenderness  and  debil- 
ity, but  seems  to  stimulate  and  tone ;  but  there  is  usually  a  slight  loss 
of  weight  after  continuous  use.  The  sense  of  warmth  produced  by 
the  Japanese  hot  baths  is  claimed  to  be  so  enduring  that  it  is  regarded 
as  an  economical  method  of  keeping  the  body  warm  in  winter  in  dwell- 
ings which  are  not  heated.  The  baths  at  Kusatu  are  natural  thermal 
waters  of  a  temperature  of  123°  F.,  and  are  much  sought  by  the  Jap- 
anese. In  these  natural  thermal  baths  the  temperature  usually  ranges 
between  119°  and  123°  for  the  bather. 

Upon  removal  from  the  very  hot  bath  the  skin  continues  to  re- 
main red  for  quite  a  time,  depending  somewhat  upon  the  individual 
and  his  peculiar  reaction.  From  the  hot  bath  a  partial  atonic  reaction 
takes  place,  followed  by  sweating,  which,  if  desired,  can  be  enhanced 
by  a  dry  pack,  retaining,  as  it  does,  the  heat  on  the  surface.  The 
pulse  remains  quickened,  and  with  the  cooling  process  gradually  re- 
turns to  the  normal.  As  stated  above,  there  is  a  popular  theory  that 
persons  are  liable  to  cold  after  a  very  hot  bath.  This  is  untrue,  for 
the  blood-vessels  remain  dilated  for  quite  a  while  and  do  not  react  to 
cold.  As  we  shall  see,  this  is  not  the  case  with  the  warm  and  tepid 
bath. 

Therapeutics  of  the  Hot  Full  Bath. — These  baths  have  obtained 
a  world-wide  reputation  in  muscular  and  chronic  rheumatism.  They 
are  the  ones  mostly  employed  at  saline  and  sulphur  thermal  springs, 
and  have  given  these  springs  some  renown  in  such  cases. 

The  daily  use  of  the  very  hot  full  bath  at  106°  to  110°  F.  for 
ten  minutes,  together  with  rubbing  and  manipulation  of  the  affected 
parts  during  the  bath,  is  the  method  most  frequently  employed.  In 
acute  alcoholic  delirium    (delirium  tremens),  in  infantile  and  other 


THE  TECHNIQUE  OF  HYDROTHERAl'Y .  153 

convulsions,  in  cerebro-spinal  meningitis,  they  have  been  employed 
with  success.  In  acute  nephritis  and  dropsy,  especially  the  nephritis 
of  the  acute  infectious  diseases  ( scarlet  fever,  measles,  diphtheria, 
etc.),  it  will  be  found  capable  of  major  service.  In  the  acute  nephritis 
of  adults  the  author  has  abandoned  its  use  for  the  safer  and  more 
satisfactory  action  of  superheated  hot  air.  Baelz  found  it  of  especial 
value  in  bronchial  pneumonia  and  capillary  bronchitis  in  children,  re- 
lieving the  congested  lung  and  easing  cough  when  the  bath  was  given 
at  104°  F.  for  five  or  ten  minutes,  two  or  three  times  in  twenty-four 
hours. 

These  baths  are  contraindicated  in  some  cases  of  arterio-sclerosis, 
in  cardiac  disease,  tabes,  myelitis,  spinal  and  cerebral  organic  disease 
and  febrile  states. 

The  Warm  Full  Bath. 

This  bath  is  administered  in  an  ordinary  tub,  which  should  be  of 
sufficient  length  to  permit  of  the  patient  reclinig  comfortably,  the 
tub  being  so  filled  as  to  cover  the  shoulders  and  body.  The  tempera- 
ture ranges  from  96°  to  100°  F.,  never  higher  than  the  last-named 
figure.  Should  the  temperatrue  of  the  water  decrease,  more  hot 
water  may  be  added  to  keep  the  temperature  up  to  the  indicated  de- 
gree. The  bath  is  given  as  follows :  The  patient's  head  and  neck 
having  been  first  bathed  in  cold  water,  with  a  cold  compress  or  ice- 
cap upon  the  head,  steps  into  and  reclines  in  the  water.  The  temper- 
ature of  the  bath  is  such  as  to  be  pleasing  and  cause  no  discomfort. 
The  duration  varies  with  the  object  in  view,  ranging  from  five  to  thirty 
minutes.  Friction  is  not  used  in  the  bath.  Its  physiological  action 
is  exerted  principally  upon  the  nervous  system.  Upon  peripheral 
nerves  we  have  the  statement  of  Hyman,  Klebs  and  Kollicker  that 
cutaneous  terminations  become  more  succulent,  and  as  a  result  are 
blunted,  receiving  and  transmitting  fewer  impressions,  for  if  a  nerve 
is  laid  in  warm  water  for  a  short  time  it  becomes  somewhat  less  irritable 
than  when  a  nerve  is  exposed  to  the  air,  while  protected  from  desic- 
cation by  evaporation.  Upon  the  brain  and  cord  it  has  been  shown. 
by  Max  SchuHer  to  cause  a  contraction  of  the  pia  matral  blood- 
vessels, which  was  sustained  for  a  long  time.  As  a  result,  the  brain 
sank  in  the  rabbits  he  trephined,  but  after  a  return  to  normal  condi- 
tions the  animal's  brain  showed  a  much  increased  pial  circulation. 
This  is  borne  out  by  experience,  and  the  writer  has  time  and  again 
tested  the  same  clinically  upon  his  own  person,  the  bath  producing 
drowsiness  and  sedation.  Its  well-known  action  in  irritable  and  con- 
vulsive states  needs  only  to  be  recalled  to  accentuate  this  fact.  The- 
cutaneous  blood-vessels  are  neither  dilated,  as  in  the  very  hot  bath, 
nor  is  there  the  tonic  reaction  following  cold  measures,  so  extra  pre^ 
cautions  must  be  taken  to  avoid  "taking  cold."     The  atonic  reaction. 


154  PRACTICAL  HYDROTHERAPY. 

following  the  bath  is  usually  accompanied  by  increased  perspiration, 
the  evaporation  of  which  will  chill  the  patient;  for  that  reason  the 
room  should  be  of  a  proper  temperature,  the  patient  quickly  but  thor- 
oughly dried,  protected  from  draughts  and  allowed  to  stir  around  as 
little  as  possible.  When  the  skin  has  been  well  dried,  place  between 
cotton  sheets,  carefully  cover,  putting  a  hot-water  bottle  to  the  feet.  The 
hair  must  be  thoroughly  dried,  and,  if  necessary,  a  dry  turban  placed 
around  the  head,  made  by  folding  a  towel  as  previously  described. 

Therapeutics  of  the  Warm  Full  Bath. — The  warm  bath  has  been 
used  to  allay  restlessness  and  reduce  pyrexia. 

"Eroess  reports  the  results  of  his  observations  upon  the  use  of 
antipyrine,  quinine,  and  warm  baths  in  the  pyrexia  of  very  young  in- 
fants. Among  431  cases  of  fever  during  the  first  ten  days  after  birth, 
145  were  of  short  duration,  the  remainder  continuing  for  several 
days;  in  184  it  was  continuous,  and  in  most  of  the  others  irregular. 
In  44  per  cent,  it  was  attributable  to  gastro-intestinal  disorders,  in  34 
per  cent,  to  some  disorder  connected  with  the  navel.  Antipyrine  was 
given  in  doses  of  from  one  grain  to  two  and  one-fourth  grains,  re- 
peated, if  necessary,  in  an  hour.  The  effect  was  good,  as  was  that  of 
quinine.  Better  results  were  obtained  from  warm  baths  than  from 
either  drug.  The  temperature  of  the  baths  was  98°  ;  duration,  ten 
minutes;  in  weakly  children,  five  minutes.  Upon  the  general  condition 
the  result  was  very  satisfactory.  Sleeplessness  and  irritability  usually 
disappeared,  and  the  child  fell  into  a  quiet  sleep,  from  which  he  awoke 
apparently  improved.  When  the  temperature  is  very  high,  a  warm 
bath  is  an  agent  of  the  greatest  value. 

"Wollisch  reports  seven  severe  cases  of  cerebro-spinal  meningitis. 
The  entire  course  of  the  disease  was  rendered  mild  by  these  baths. 
The  favorable  influence  on  the  heart  and  nervous  system  was  well 
marked.  The  baths  were  administered  in  a  somewhat  different  man- 
ner from  Aufrecht's  method.  The  patient  was  put  into  a  bath  of 
the  temperature  of  90°,  and  gradually  hot  water  was  added  until  the 
temperature  of  the  water  reached  102°.  During  the  bath  the  ice-bag 
or  Leiter's  coil  was  applied  to  the  head. 

"The  transportation  from  the  bed  to  the  bath  should  be  conducted 
most  carefully  and  as  quickly  as  possible.  If  a  great  deal  of  pain  is 
present  in  the  spine,  the  patient  must  be  lifted  out  of  the  bed  by 
means  of  the  sheet  on  which  he  lies,  and  with  it  lowered  into  the  bath. 
The  head  should  not  be  touched  during  transportation.  After  the 
bath  the  patient  is  wrapped  in  a  woolen  blanket  and  has  a  light  cover 
thrown  over  him ;  no  drying  or  rubbing  of  the  body  is  to  be  attempted. 
In  this  envelopment  the  patient  is  to  remain  an  hour,  when  he  may 
be  removed.  The  time  of  day  for  the  bath  is  unimportant,  but  the 
very  early  morning  hours  or  late  evening  hours  should  not  be  selected." 
( Baruch. ) 

The  warm  full  bath  has  been  used  for  diagnostic  purposes.  Strieker1 
says  it  permits  the  abdominal  organs  to  be  palpated,  and  may  be  used 
in  place  of  an  anesthetic.  He  has  diagnosticated  displacements  and 
adhesions  of  the  abdominal  organs ;  atrophy  and  enlargement  of  the 

1   Centralblatt    f.    Innere    Medizin,    March    5,    1904. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  155 

liver,  spleen  and  kidney;  calculi  in  the  gall-bladder  and  renal  pelvis; 
exudate-  and  minors  which  could  be  felt  vaguely  or  not  at  all  by  the 
ordinary   methods  of  palpation. 

From  personal  observations  the  author  has  seen  good  results  from 
these  baths  in  the  various  forms  of  meningitis,  and  in  recent  literature 
cases  have  been  reported  in  which  they  proved  of  service. 

In  various  functional  and  nutritional  nervous  disorders,  in  insom- 
nia, irritabilty  and  nervousness,  the  author  prefers  the  neutral  bath, 
to  be  described  later. 

The  Cleansing  Bath. 

As  a  natural  corollary  to  its  therapeutic  action,  we  next  take  up  the 
full  warm  bath  as  a  cleansing  agent.  The  ordinary  tub  is  filled  with 
water  at  96°  to  100°  F.  and  the  body  immersed.  The  skin  having 
become  softened  by  contact  with  the  warm  water,  is  then  thoroughly 
soaped,  rubbed  with  the  hand  or  flesh-brush  and  the  lather  then 
removed.  After  the  skin  is  thoroughly  cleansed  it  is  dried,  preferably 
with  a  coarse  Turkish  towel.  The  aim  of  this  bath  is  cleanliness ;  it 
softens  the  epithelium  and  debris  upon  the  surface,  rendering  them 
better  suited  to  removal.  The  alkali  (soap)  aids  in  saponifying  the 
greasy  elements  as  well  as  softening  and  dissolving  the  epithelium  or 
scales.  It  goes  without  saying  that  a  brush,  by  its  mechanical  action, 
quickly  removes  the  various  excreta.  A  cleansing  bath  should  be 
taken  at  least  three  times  weekly  m  cold  weather  and  every  day  in 
summer,  though  in  summer  the  use  of  soap  is  hardly  necessary  each 
day.  The  value  of  the  cleansing  bath  lies  in  its  removal  from  the 
surface  of  various  foreign  impurities,  preventing  the  clogging  up  of 
the  mouths  of  the  various  glandular  ducts  or  "pores"  that  open  their 
millions  of  mouths  upon  the  skin.  It  will  be  recalled  that,  in  speaking 
of  the  skin  in  an  earlier  chapter,  its  physiologic  action  was  that  of  an 
excretory  organ,  and  for  this  as  well  as  for  esthetic  considerations  of 
those  around  us  the  skin  should  be  kept  clean.  In  winter,  when  baths 
are  less  frequently  taken,  the  use  of  the  flesh-brush  between  baths 
will  aid  in  preventing  accumulations  of  cuticle  and  dirt. 

The  bather  is  left  open  to  the  danger  of  "catching  cold."  This  can 
be  easily  averted  by  the  use  of  the  shower  ordinarily  found  in  private 
homes.  The  cold  shower  causes  a  reaction,  the  bath  being  thereby 
more  beneficial  and  colds  prevented.  The  very  young,  the  very  old, 
and  the  sick  do  not  stand  cold  water  well,  as  a  rule,  but  there  are  few, 
indeed,  that  cannot  be  educated  to  react  and  derive  benefit  therefrom. 

In  this  connection  a  word  might  be  profitably  said  with  regard 
to  the 

Bathing  of  the  Infant. 

It  may  be  taken  as  a  general  rule  that  young  infants  and  children 
are  coddled   as   regards  cold  water,  and  this   is  especially  true  with 


156  PRACTICAL  HYDROTHERAPY. 

regard  to  girls.  No  newly-born  baby  is  to  be  plunged  into  a  cold  water 
bath,  but  by  gradually  diminishing  the  temperature  they  can  soon  be 
taught  to  stand  reduced  temperatures.  In  summer,  when  they  are 
suffering  from  all  that  babies  have  to  endure,  especially  in  a  large  city, 
their  resistive  power  and  vitality  can  be  greatly  increased  by  bathing 
or  sponging  them  several  times  daily  with  cold  water.  It  has  a  valuable 
effect  in  reducing  the  diarrheal  influence  of  summer.  By  bathing,  by 
keeping  them  out  of  doors,  clothed  in  little  cotton  garments,  as  nearly 
savage  as  possible,  babies  and  little  children  will  be  spared  many  hours 
of  suffering,  mothers  weeks  and  sometimes  years  of  anxiety,  for  some 
diseases,  starting  in  infancy,  cling  to  maturity  or  even  unto  the  grave 
itself. 

The  Neutral  Bath. 

The  neutral,  or  indifferent,  is  a  full  bath,  and  is  administered  in 
the  same  manner  as  the  preceding  forms  of  application  of  this 
measure — that  is  to  say,  with  an  ordinary  tub  of  sufficient  length  to 
permit  of  the  patient's  reclining  comfortably  with  the  shoulders  and 
body  well  covered  with  water.  The  author  believes  that  the  term 
neutral  more  nearly  describes  this  bath  than  any  other,  as  it  literally 
occupies  the  peculiarly  unique  position  of  being  "a  neutral"  between 
the  extremes  of  hot  and  cold.  The  temperature  of  the  bath  ranges 
between  94°  and  96°  F.,  and  should  never  be  administered  higher 
than  the  last-named  figure.  As  its  duration  is  usually  over  lengthy 
periods  of  time,  it  is  essential  that  more  hot  water  be  added  should 
the  temperature  fall  below  the  indicated  figure.  The  bath  is  admin- 
istered as  follows :  The  tub  having  been  filled  to  sufficient  depth  and 
the  proper  temperature  secured,  the  patient  steps  into  and  reclines 
in  the  water.  A  strap,  head-rest  or  pillow  should  be  so  arranged  as 
to  enable  the  patient's  head  to  be  perfectly  comfortable.  The  question 
of  a  cold  compress  to  the  head  is  one  that  may  be  left  entirely  to  the 
patient's  wishes. 

The  duration  of  the  bath  ranges  from  one-fourth  to  one  hour, 
although,  as  we  shall  see,  it  may  be  administered  continuously  for 
weeks  or  even  months  at  a  time.  No  friction  is  used,  all  mechanical 
effects  being  avoided  before,  during  and  after  the  bath,  for  its  object 
is  sedative,  and  therefore  any  measure  that  possesses  stimulating  effects 
should  be  omitted. 

Physiological  Action  of  the  Neutral  Bath. — The  physiological 
action  of  the  neutral  bath  is  almost  entirely  limited  to  the  nervous 
system,  and  it  is  for  this  reason  that  it  has  attained  such  a  position 
as  a  calmative  agent.  Upon  first  entering  the  bath  there  is  a  slight 
sensation  of  coolness,  followed  by  a  sense  of  comfort.  It  lowers 
surface,  although  buccal  temperature  is  not  affected,  a  fact  which  the 
author  has  repeatedly  and  carefully  tested.     It  produces  no  thermic 


— 
n 

o 

o 


~ 


^g^Q^ 


THE  TECHNIQUE  OF  HYDROTHERAPY.  157 

reaction  whatever,  and  in  this  respect  occupies  an  unique  niche  in 
hydrotherapeutic>.  [ts  action  upon  the  circulation  is  negative,  although 
the  pulse-rate  is  moderately  diminished.  There  is  no  circulatory 
reaction  and  should  be  none,  as  the  aim  is  distinctly  to  avoid  such 
reaction.  Upon  respiration  and  tissue  change  it  is  also  negative." 
Upon  the  nervous  system,  however,  we  find  the  neutral  hath  a  central 
and  peripheral  sedative  of  no  mean  value,  and  it  is,  in  fact,  the  most 
purely  sedative  application  within  the  whole  range  of  hydrotherapy. 
As  before  stated,  in  the  full  warm  bath  Hyman  and  Krebs  have  shown 
that  by  the  absorption  of  water  the  nerve  terminals  in  the  skin  become 
succulent  and  blunted  and  convey  fewer  impressions  from  the  surface. 
This  is  true;  but  in  addition  reflex  irritability  is  much  lessened. 
Enveloped  and  protected  as  the  skin  is  by  the  bath  of  neutral  tempera- 
ture, it  must  follow  naturally  that  impressions  from  the  exterior  are 
mechanically  shut  off  and  an  additional  sedative  action  thereby  gained. 
Others  have  stated  that  the  action  of  the  water  upon  the  peripheral 
nerve  endings  was  not  really  that  of  absorption  from  the  water  of  the 
bath  itself,  but  that  the  water  of  exhalation  was  retained  within  the 
skin  and  the  nerve  structures  thereby  became  saturated  with  their  own 
water  rather  than  by  direct  absorption.  The  fact  remains,  never- 
theless, that  nerve  sensibility  is  decreased,  no  matter  which  explana- 
tion or  theory  is  accepted.  Upon  the  brain  and  spinal  cord  the 
neutral  bath  is  reflexly  a  sedative,  quieting  cerebral  action  and  in- 
ducing drowsiness. 

This  is  possibly  assisted  by  the  increased  quantity  of  blood  at  the 
surface  inducing  cerebral  anemia.  The  lessening  of  reflex  action 
from  the  surface  has  a  contributory  influence  in  causing  cerebral  and 
spinal  sedation.  The  action  of  the  neutral  bath  upon  elimination  is 
principally  shown  in  the  urinary  secretion,  in  which  the  water  is 
increased  and  its  acidity  diminished.  The  bath  is  likewise  open  to 
the  same  objection  as  the  full  warm  bath,  in  that  the  patients  are 
liable  to  chill  and  catch  cold.  For  that  reason  they  should  be  quickly 
and  promptly  dried,  without  friction  and  carefully  covered  to  prevent 
loss  of  heat.  Unless  this  is  done  evaporation  takes  place  from  the 
surface  and  patients  suffer  evil  rather  than  good  results  from  its 
application.  Should  the  hair  be  damp  it  must  be  carefully  dried  and 
if  necessary  covered  by  a  turban. 

Therapeutic  Application  of  the  Neutral  Bath. — It  is  in  the  domain 
of  nervous  diseases  that  the  neutral  bath  reaches  its  highest  degree  of 
efficiency,  particularly  in  the  functional  and  nutritional  disorders  of  this 
domain  of  medicine.  Worthy  of  a  special  and  separate  description 
is  its  use  in  insomnia,  the  author  having  demonstrated  it  to  be  one  of 
the  most  satisfactory  and  safest  of  physiologic  hypnotics.  In  the 
management  of  habitues  of  morphine,  chloral,  cocaine  and  alcohol 
this  bath  can  be  applied  with  the  confident  assurance  of  immediate 


158  PRACTICAL  HYDROTHERAPY. 

temporary  and  eventual  permanent  benefit.  In  neurasthenia  and 
hysteria  the  writer  has  not  found  it  of  signal  benefit  as  the  more 
stimulating  and  tonic  forms  of  hydrotherapy,  but  has  used  it  especially 
for  the  relief  of  the  insomnia  that  usually  accompanies  the  condition. 
In  cases  of  renal  insufficiency  it  may  be  counted  upon  to  provoke  a 
free  excretion  from  these  organs.  The  writer  has  frequently  sug- 
gested the  use  of  the  neutral  bath  at  bedtime,  to  busy  and  overworked 
professional  and  business  men  who,  while  they  are  not  really  sick, 
still  need  some  satisfactory  hypnotic  to  produce  physiological  rest 
and  sleep.  In  pruritus  this  bath  relieves,  especially  those  that  have 
their  origin  in  the  more  purely  nervous  and  vasomotor  conditions  of 
the  skin.  The  author  recalls  an  interesting  case  of  this  character  in 
a  physician  who  was  under  his  care  several  years  ago  and  who 
obtained  immediate  relief  from  the  neutral  bath.  In  the  painful  states 
that  accompany  neuritis,  both  simple  and  multiple,  much  relief  and 
comfort  may  be  obtained  by  the  use  of  this  bath,  as  it  shuts  out 
peripheral  irritation  and  in  that  way  lessens  pain  and  suffering.  This 
bath  is  especially  suited  for  private  practice,  if  patients  were  only 
willing  to  undertake  and  carefully  carry  out  the  physician's  in- 
structions. 

In  conclusion,  it  might  be  stated  that  it  is  well  to  use  during  the 
day  time  stimulating  hydrotherapy  and  thus  avoid  any  debilitating 
influence  that  might  arise  from  the  bath. 

One  of  the  most  lasting  impressions  the  writer  ever  received 
during  his  European  sojourn,  was  -the  influence  of  the  neutral  bath 
as  applied  to  the  treatment  of  mental  disease.  This  was  observed  in 
its  use  in  Bethlem  Hospital,  London ;  maniacal  cases  became  calm 
and  quiet  by  an  hour's  sojourn  in  the  bath,  and  in  this  hospital,  as  well 
as  in  several  on  the  continent,  the  method  has  been  employed  with 
much  success. 

In  this  connection  we  should  consider 

The  Continuous  Bath, 

which  is  nothing  more  or  less  than  the  neutral  bath  continued  for 
hours,  days,  weeks  or  even  months  at  a  time.  This  bath  is  in  the 
author's  experience  rarely  employed  in  America,  but  is  used  quite  a 
good  deal  in  certain  places  upon  the  continent  of  Europe.  The 
method  of  its  application  is  somewhat  different,  in  that  a  larger  bath 
tub  must  be  provided,  with  a  set  of  hooks  or  buttons  along  the  outside, 
by  means  of  which  a  sheet  can  be  secured  with  strings  or  tapes.  The 
object  of  this  is  to  suspend  the  sheet,  with  the  patient  upon  it,  within 
the  tub,  yet  completely  immersed  in  the  water.  The  sheet  should  be 
so  arranged  that  it  will  not  touch  the  bottom  of  the  tub,  but  will 
suspend  the  patient  entirely  in  the  water,  similar  to  the  position 
assumed  by  one  lying  in  a  hammock,  although  this  is  not  absolutely 


bd 


THE  TECHNIQUE  OF  HYDROTHERAPY.  159 

necessary.  The  patient  must  be  comfortable  if  the  tub  is  to  become 
his  habitation  for  many  hours  or  weeks.  A  rubber  air  pillow  should 
be  adjusted  beneath  his  head.  Arrangements  must  be  made  for  main- 
taining a  continuous  neutral  temperature,  and  the  most  satisfactory 
way  in  which  this  can  be  accomplished  is  to  have  the  "mixed"  faucet 
of  hot  and  cold  water  entering  at  one  end  and  an  outlet  at  the  other. 
It  is  essentia]  that  the  water  be  protected  from  the  atmosphere  and 
all  drafts.  This  is  easily  secured  by  fitting  wide  supporters  across 
the  top  of  the  tub  and  covering  them  with  blankets.  It  is  necessary 
to  remove  the  patient   for  the  purpose  of  urination   and  defecation. 

This  bath  is  usually  applied  both  day  and  night,  and  for  that 
reason  as  well  as  watching  the  temperature  of  the  water  a  nurse  is 
required  to  be  in  constant  attendance.  Unless  care  is  exercised  the 
skin  will  peel  and  pucker  under  prolonged  immersion,  but  this  can  be 
obviated  by  the  use  of  mutton  suet  or  some  other  oleaginous  prepa- 
ration. 

Baruclr  says:  "To  Reiss,  who  studied  this  unique  bath  method 
thoroughly  in  a  large  number  of  cases  from  1874  to  1876,  we  owe  all 
that  is  known  of  its  application  for  the  treatment  of  internal  diseases. 
The  physiological  effects  upon  the  organism  which  may  be  expected 
from  lying  in  a  bath  of  from  94°  to  95°  F.,  either  continuously  night 
or  day,  or  for  a  number  of  hours,  are  of  a  negative  character.  There 
is  neither  a  thermic  irritation  of  the  sensory  cutaneous  nerve  endings, 
nor  any  change  in  the  cutaneous  vessels,  blood  pressure,  cardiac 
action  or  respiration.  In  every  case  in  which  Reiss  applied  the  con- 
tinuous bath  he  made  careful  temperature,  pulse  and  respiratory 
measurements,  which  demonstrated  that  the  last  two  usually  fluctuated 
only  for  a  short  time  after  the  bath  was  entered.  The  most  reasonable 
explanation  of  the  effect  of  the  continuous  neutral  bath  is  to  be  sought 
in  the  diminution  or  removal  of  those  cutaneous  irritations  (rapidly 
changing  temperatures,  etc.)  which  are  in  operation  in  the  ordinary 
contact  of  the  body  with  air,  and  the  resultant  effect  of  this  freedom 
from  communicated  irritating  influences  upon  the  inner  organs,  espe- 
cially the  nervous  system."  The  continuous  bath  is  useful  in  serious 
disturbances  of  the  central  nervous  system,  especially  of  the  spinal 
cord.  In  those  conditions  of  paraplegia  of  the  lower  extremities, 
paralysis  of  the  bladder  and  intestines  occurring  in  locomotor  ataxia, 
myelitis,  and  similar  diseases,  it  is  especially  useful.  Despite  the 
greatest  care,,  bedsores  occur  and  progress  to  serious  proportions  in 
these  cases,  compelling  resort  to  the  continuous  bath,  which  has 
proved  to  be  the  most  effective  remedy  for  this  serious,  discom- 
forting and  painful  trouble.  It  was  through  his  treatment  of  bed- 
sores that  Reiss  obtained  surprising  results  in  the  improvement  and 
retrocession  of  organic  nervous  diseases,  such  as  spinal  pains,  eccentric 

2  Ibidem. 


160  PRACTICAL  HYDROTHERAPY. 

pains  in  the  extremities  and  contractures  which  often  rendered  any 
position  in  bed  painful  and  caused  reflex  spasms  and  similar  mani- 
festations. 

Prolonged  submersion  in  water  of  neutral  temperature  exercises 
a  calming  effect  upon  the  irritability  of  the  brain  and  offers  a  basis 
for  favorably  influencing  those  diseases  of  the  nervous  system,  in 
which  therapeutic  efforts  are  usually  so  fruitless.  "In  about  one-half 
of  the  cases  of  spinal  and  cerebral  organic  disease,  which  exceeded 
one  hundred  and  which  were  subjected  to  these  baths  for  several 
weeks,  the  improvement,  not  only  of  the  symptoms,  but  in  the  disease 
itself,  was  undeniable.  The  motor  and  sensory  paralysis,  ataxia  and 
related  symptoms  receded  under  the  baths,  although  they  had  been 
but  slightly  influenced  or  remained  unaffected  under  the  use  of  other 
therapeutic  measures  which  had  been  applied  during  many  preceding 
months."     (Reiss.) 

During  the  author's  sojourn  in  Vienna  he  had  the  pleasure  of 
seeing  some  of  the  work  at  Prof.  Hebra's  clinic  with  the  continuous 
bath  for  extensive  burns  and  some  very  chronic  conditions  of  skin 
trouble.  The  results  obtained  were  satisfactory,  and  the  author  be- 
lieves this  bath  should  be  much  more  often  used  than  it  is. 

All  are  familiar,  doubtless,  with  the  interesting  accounts  of  the 
continuous  bath  as  administered  at  Leukerbad,  Switzerland,  in  which 
the  patients  remain  immersed  for  weeks  at  a  time  in  a  large  pool. 
Those  that  are  capable  of  moving  about  play  cards,  eat  their  meals 
upon  floating  tables,  and  in  other  ways  relieve  the  tedium  of  their 
confinement  in  the  water. 

The  Nauheim  or  Effervescent  Bath. 

The  Nauheim,  effervescent,  or  carbon  dioxide  bath  has  become 
one  of  the  fully  recognized  procedures  of  hydrotherapy,  and  is  most 
efficient  in  the  treatment  of  certain  diseases,  especially  those  of  the 
heart.  With  these  baths  the  names  of  the  Drs.  Schott  will  be  indel- 
ibly associated,  for  it  was  through  their  unceasing  scientific  labors 
that  the  baths  of  Nauheim  gained  their  reputation  and  produced  such 
excellent  results.  It  is  interesting  to  note  the  wide  liberality  and 
breadth  of  mind  found  in  the  announcement  of  Drs.  Schott,3  who 
have  insisted  that  the  artificial  baths  possess  similar  if  not  nearly 
identical  effects,  provided  that  they  are  so  prepared  as  to  resemble 
the  natural  Nauheim  baths  in  their  principal  ingredients,  and  that 
by  varying  the  quantity  of  saline  used  and  the  amount  of  efferves- 
cence graduated,  results  can  be  obtained  practically  identical  to  those 
of  the  natural  waters  of  this  famed  spa.  It  will  therefore  be  seen 
that  the  discovery  was  not  of  a  unique  water,  but  of  a  method  and 
principle  of  hydriatic  application. 

3   See   Diseases   of  the   Heart. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  161 

For  this  bath,  the  usual  porcelain-lined  or  wooden  tub  may  be 
used,  of  sufficient  length  to  permit  the  patient  to  recline  comfortably. 
I  prefer  a  tub  about  seven  feet  long  and  broad,  so  as  to  have  ample 
room.  The  tub  should  be  filled  with  water  at  a  temperature  of  from 
90°  to  94°  F.,  it  being  well  to  commence  with  the  neutral  temperature 
of  94  I'.,  a  reduced  quantity  of  salines  and  hydrochloric  acid.  With 
succeeding  baths  these  latter  may  be  increased  and  the  temperature 
lowered. 

The  simplest  formula  used  in  this  country  is  that  of — 

Sodium   carbonate    (Na2CO:j)     300   grams. 

Commercial  hydrochloric  acid   (HC1) 300  grams. 

This  to  be  gradually  increased  to  800  to  1,000  grams  each  of  salt 
and  acid. 

Another  formula  consists  of — 

Sodium    chloride    8  lbs. 

Calcium  chloride    12  oz. 

Sodium  bicarb - 1   lb. 

Commercial  hydrochloric  acid   1^2   lbs. 

In  preparing  these  baths  the  saline  ingredients  should  be  first  dis- 
solved and  then  the  HC1  added.  To  rapidly  prepare  the  bath,  invert 
the  bottle  below  the  level  of  the  water,  remove  the  stopper  and  move 
the  bottle  over  the  surface  of  the  bath,  so  as  to  distribute  the  acid 
evenly  over  the  surface  and  secure  uniform  effervescence. 

"Hydrochloric  acid  may  be  dispensed  with  by  employing  the  sub- 
stances indicated  in  the  subjoined  formula.  The  powders  are  dis- 
solved in  the  water  in  an  ordinary  full  bath.  No  harm  is  done  to 
tin-lined  copper  tubs. 

"formula   for  one   powder. 

"Sodium  carb.  (sal  soda)    V/2  lbs. 

Calcium  chloride  3      lbs. 

Sodium  bicarb /^  lb- 
Sodium  chloride    2      lbs. 

Sodium  bisulphate 1      lb. 

"Mix  and  dissolve  the  first  four  ingredients;  then  add  slowly  the 
sodium  bisulphate.  which  should  be  kept  by  itself.  It  is  not  desirable 
to  produce  very  marked  effervescence,  but  rather  to  secure  the  sat- 
uration of  the  water  of  the  bath  with  C02.4 

"The  carbonic  acid  gas  is  produced  by  this  formula  very  slowly,  so 
that  it  is  nearly  all  absorbed  by  the  water,  thus  making  the  method 
an  economical  one. 

"It  should  be  remembered  that  it  is  the  C02  dissolved  in  the  water, 
and  not  that  which  escapes  by  effervescence,  that  produces  the  de- 
sired effect  upon  the  skin.  Generally  the  bath  should  be  taken  two 
or  three  days  in  succession  each  week,  then  one  day's  respite  be  al- 
lowed. With  persons  in  good  strength,  four  or  five  successive  baths 
may  be  given."    (KelloggJ ____ 

4  Each   bath   costs   about   eighty   cents. 


xn 


162  PRACTICAL  HYDROTHERAPY. 

Some  idea  as  to  how  these  baths  may  be  graded  from  weak  to 
strong  may  be  gained  from  the  schedule  below.  Each  bath  consists 
of  forty  gallons  of  water: 

Bath  Xo.  1 — Temperature  94°  F.,  duration  5  minutes,  sodium 
chloride  4  lbs.,  calcium  chloride  6  oz. 

Bath  No.  2 — Temperature  92°  F.,  duration  6  minutes,  sodium  chlo- 
ride 5  lbs.,  calcium  chloride  8  oz. 

Bath  Xo.  3 — Temperature  90°  F.,  duration  7  minutes,  sodium  chlo- 
ride 6  lbs.,  calcium  chloride  10  oz.,  sodium  bicarbonate  8  oz.,  HC1  7  oz. 

Bath  No.  4 — Temperature  88°  F.,  duration  8  minutes,  sodium  chlo- 
ride 6  lbs.,  calcium  chloride  10  oz.,  sodium  bicarbonate  8  oz.,  HC1  7  oz. 

Bath  Xo.  5 — Temperature  88°  F.,  duration  8  minutes,  sodium  chlo- 
ride 7  lbs.,  calcium  chloride  10  oz.,  sodium  bicarbonate  8  oz.,  HC1  10  oz. 

Bath  Xo.  6 — Temperature  87°  F.,  duration  10  minutes,  sodium  chlo- 
ride 7  lbs.,  calcium  chloride  10  oz.,  sodium  bicarbonate  8  oz.,  HC1  10  oz. 

Bath  Xo.  7 — Temperature  87°  F.,  duration  10  minutes,  sodium  chlo- 
ride 8  lbs.,  calcium  chloride  11  oz.,  sodium  bicarbonate  12  oz.,  HC1 
14  oz. 

Bath  Xo.  8 — Temperature  85°  F.,  duration  12  minutes,  sodium  chlo- 
ride 8  lbs.,  calcium  chloride  11  oz.,  sodium  bicarbonate  12  oz.,  HC1 
14  oz. 

Bath  Xo.  9 — Temperature  85°  F.,  duration  12  minutes,  sodium 
chloride  10  lbs.,  calcium  chloride  12  oz.,  sodium  bicarbonate  1  lb., 
HC1  1  lb. 

Bath  Xo.  10 — Temperature  85°  F.,  duration  15  minutes,  sodium 
chloride  10  lbs.,  calcium  chloride  12  oz.,  sodium  bicarbonate  1  lb., 
HC1  1  lb. 

Baths  Xos.  11-20. — Temperature  83  F.,  duration  15  minutes, 
sodium  chloride  10  lbs.,  calcium  chloride  12  oz.,.  sodium  bicarbonate 
1  lb.,  HC1  \y2  lbs. 

Another  method  that  may  be  employed  is  that  of  the  "Triton 
Salts,"  as  follows :.  Fifty  gallons  of  water  to  which  is  added  five 
pounds  of  common  or  sea  salt  and  the  contents  of  the  bag  of  sodium 
bicarbonate.  The  bottom  of  the  tub  is  then  covered  with  rubber 
sheeting.  On  this  rubber  sheeting  place  the  eight  acid  cakes  from 
the  box  of  Triton  salts  so  that  two  shall  be  at  the  back,  two  on  each 
side  of  the  body,  and  two  under  the  knees.  The  bath  is  now  complete. 
In  about  three  minutes,  when  effervescence  is  well  under  way,  the  pa- 
tient should  lie  down  in  the  bath  and  rest  quietly  without  unnecessary 
movement.  The  temperature  and  duration  must  be  graduated.  It 
can  be  regulated  by  using  more  salt,  up  to  fifteen  pounds,  and  fewer 
number  of  acid  cakes,  during  the  first  few  baths.  The  author  does 
not  believe  in  the  use  of  carbon  dioxide  gas ;  the  tanks  and  apparatus 
are  cumbersome;  it  is  more  expensive  (with  me)  and  the  evolution 
of  gas  is  too  rapid. 


Plate  89— Continuous  Bath,  or  Bathing  at  Leukebad,  Switzerland. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  163 

The  duration  of  these  baths  should  be  carefully  graded  to  meet 
the  patient's  strength  and  requirements.  For  an  average  case  eight 
minutes'  duration,  gradually  increased  to  fifteen  minutes,  is  a  good 
rule,  remembering  that  the  time  of  the  previous  bath  should  not  be 
lengthened  when  the  acid  or  saline  constituents  are  increased,  but  a 
bath  should  intervene.  Twenty  or  thirty  baths  usually  constitute  "a 
course,"  a  day  being  allowed  to  intervene  after  every  third  or  fourth 
bath.  The  saline  and  acid  is  begun  weak,  the  temperature  high 
(94(  V.),  the  duration  short  (five  minutes).  Increase  the  quantity 
of  the  constituents  and  carbonic  acid  gas  gradually  and  reduce  the 
temperature  (94°)  two  degrees  daily  to  83°  F.,  or  even  lower.  The 
patient  reclines  quietly  in  the  tub.  He  must  not  talk.  When  the  time 
elapses  he  is  assisted  from  the  tub  and  rubbed  dry  with  a  warm  towel, 
avoiding  exertion  or  exposure.  It  is  best  to.  remain  quiet,  or,  better, 
recline  for  one  hour  after  the  bath.  Where  there  are  infiltrations  or 
deposits  in  the  system  local  massage  may  be  applied  to  them  after 
the  bath.  The  pulse  should  be  counted,  percussion  and  auscultation 
performed,  notes  and  diagrams  made  both  before  and  after  the 
bath. 

Schott3  calls  attention  to  the  fact  that  the  chloride  of  sodium  and 
calcium  are  the  salts  most  active  in  the  waters  of  Nauheim.  For 
cardiac  disease  the  baths  are  given  in  conjunction  with  graduated 
resistive  exercises.  It  should  be  noted  that  the  Xauheim  bath  is 
a  saline,  carbonic  acid  gas,  neutral  bath,  in  the  great  majority  of 
instances,  immersion  in  which  produces  a  transient  chilliness,  ac- 
companied by  a  sensation  of  oppression  of  the  precordia  and  res- 
piration, lasting  but  a  moment.  As  this  passes  away  the  respira- 
tions become  slower,  fuller  and  deeper,  the  reduction  amounting 
in  ordinary  cases  from  two  to  four  per  minute,  unless  the  respiration 
is  very  rapid,  when  they  are  correspondingly  reduced.  As  the  res- 
piration quiets  the  lung  capacity  is  increased  and  the  exchange  of 
O  and  C02  favored.  The  thermic  influence  is  small,  and  temperature 
is  little  affected,  compensation  being  rapid.  After  immersion  minute 
bubbles  of  carbon  dioxide  collect  upon  the  surface  of  the  skin,  and 
recur  immediately  when  brushed  off.  These  bubbles,  in  the  presence 
of  a  saline  medium,  affect  profoundly  the  superficial  nerves,  resulting 
in  marked  vasomotor  effects,  by  which  the  cutaneous  circulation  is 
stimulated,  the  blood-vessels  dilating  and  the  column  of  blood  thereby 
being  directed  to  the  periphery.  This  flooding  of  the  skin  "lifts  the 
load"  from  the  heart,  sucks  the  blood  from  the  congested  viscera  of 
thorax  and  abdomen,  thereby  better  "equalizing"  the  distribution  and 
movement  of  this  fluid.  In  normal  individuals  I  have  observed  a  fall 
of  ten  and  even  fifteen  beats,  while  very  rapid  pulses  may  be  reduced 


5   Schott,   A.:     Blaetter  f.    Klini?che   Hydrotherapie.    1SS0;    Schctt,   Theo. :     Medical   Record, 
March   11,   1899,   p.   345;    Medical  Record,   March  26,    1898. 


164  PRACTICAL  HYDROTHERAPY. 

thirty  to  forty  beats  by  a  single  bath,  meaning  reduced  cardiac  labor. 
This  surface  effect — that  is,  lessened  peripheral  resistance  and  firmer 
cardiac  action — is  a  response  that  resembles  the  action  of  digitalis 
and  nitroglycerine,  without  their  drawbacks.  The  heart  is  directly 
affected.  If  it  is  auscultated  and  the  pulse  studied  before,  during  and 
after  the  bath,  it  is  found  that  the  heart  beats  slower  and  stronger; 
the  rhythm  becomes  regular,  and  the  sounds  clear.  Systole  and 
diastole  are  both  prolonged,  the  arteries  dilated.  The  pulse  grows 
full,  increases  in  force,  and  the  blood  pressure  rises  to  the  extent  of 
20  or  30  mm.,  denoting  a  greater  quantity  of  blood  in  the  arterial 
system.  The  vertical  sphygmograph  lines  are  higher  and  the  hori- 
zontal ones  wider,  indicating  a  longer  time  for  the  passage  of  blood 
from  aorta  to  capillaries.  If  these  conditions  are  carefully  studied 
it  will  be  readily  seen  that  there  is  a  beneficial  stimulation  to  the 
heart  which  must  augment  its  tone  and  improve  innervation  of  the 
cardiac  muscle.  The  enlarged  and  feeble  heart  is  contracted  often 
20  per  cent,  during  a  single  bath  (see  cutj.  One  has  to  see  these 
results  to  be  willing  to  accept  such  a  seemingly  improbable  statement. 
This  reduction  of  area,  as  shown  by  percussion,  is  accompanied  by 
marked  increase  of  cardiac  power,  with  lessened  resistance  to  heart 
action.  In  old  cases  of  valvular  lesions  the  increased  rest  afforded 
the  heart  muscle  enables  it  to  feed,  regenerate,  hypertrophy  and  thus 
compensate  its  lesions,  a  result  that  is  curative,  and  that  cannot  be 
obtained  by  drugs.  With  the  resistance  to  the  flow  of  blood  de- 
creased, a  weak  or  dilated  heart  muscle  contracting  fully  compensates, 
following  the  physical  law  that  a  muscle  that  works  naturally  in- 
creases its  tissue  and  strength,  consequently  hypertrophies.  Another 
beneficial  effect  of  the  dilatation  of  the  peripheral  arteries  is  the 
reduction  of  intracardiac  pressure,  a  no  mean  factor  in  promoting 
the  contraction  of  a  dilated  heart.  A  fortunate  feature  of  the  bath 
is  its  eliminating  action  upon  rheumatic  toxins,  because  of  the  frequent 
association  of  rheumatism  as  a  cause  and  concomitant  of  heart  disease. 
Heart  sounds  are  rendered  clearer  and  abnormal  sounds,  which  were 
not  noticeable  before  the  bath,  are  plainly  brought  out,  and  ausculta- 
tion more  clearly  reveals  the  real  condition  of  the  organ.  The  in- 
creased metabolism  that  follows  the^e  baths  is  due  to  better  elimina- 
tion and  circulation,  for  with  the  relief  of  the  congestion  existing 
the  metabolic  and  cellular  processes  of  the  body  take  on  renewed 
functional  activity,  this  being  especially  true  of  the  abdominal  and 
pelvic  organs.  In  view  of  this  it  is  not  surprising  that  the  kidneys 
begin  to  act  more  freely  and  continue  to  do  so  for  a  long  time  after 
the  baths  are  discontinued.  The  peripheral  nerves  are  promptly 
affected  by  these  baths,  transmitting  the  impressions  made  by  the 
thermic  stimuli  ( where  the  bath  is  below  92°  R),  the  saline  medium 
and  CO,  gas,   from  the  surface,  through  the  spinal  cord  to  cerebral 


'ftCoJ^^cMj^ 


Mr 


^*tf&' 


/^-©-^KA^Jp^A^  . 


Plate   90— Diagram    of    Cardiac    Area    of    Dullness    Before    and    After 

Nauheim  Rath. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  165 

centers  associated  with  the  vasomotor  and  cardiac  apparatus,  and 
from  them  through  the  pneumogastric  to  the  cardiac  ganglia,  and 
from  the  vasomotor  centers  peripherally  to  the  cutaneous  and  associ- 
ated vascular  trunks.  Upon  nerve  tissue  it  is  stimulant  to  renewed 
activity,  producing  tone  and  exhilaration,  and  in  those  neurasthenic 
cases  complicated  with  cardiac  trouhle,  changes  remarkable  to  behold 
follow  its  use. 

It  will  thus  be  seen  that  the  Xauheim  bath  acts  upon  the  smaller 
blood-vessels  and  capillaries  of  the  surface;  that  they  are  dilated; 
that  ventricular  contraction  is  relieved ;  causes  a  slowed  pulse  and 
completely  emptied  heart ;  toned  capillaries  and  greater  volume  of 
distal  circulation ;  better  neuro-cardiac  action ;  increased  action  of 
skin  and  kidneys ;  trophic  and  other  nerve  influences. 

Therapeutics  of  the  Nauhcim  Bath. — The  greatest  usefulness  of 
this  bath  lies  in  the  domain  of  cardiac  and  vascular  disease,  for  it 
possesses  all  the  value  of  hot  and  cold  baths  without  the  disadvantage 
of  the  extremes  of  temperature,  in  the  one  instance  (hot)  preventing 
harmful  excitement  and  in  the  other  (cold)  avoiding  the  increased 
work  placed  upon  the  heart  itself.  It  should  be  distinctly  borne  in 
mind,  however,  that  the  Xauheim  bath  in  the  treatment  of  heart  dis- 
ease is  but  a  part  of  a  system  of  baths  and  graduated  exercises,  and 
that  these  latter  play  a  most  prominent  part.  In  cardiac  disease  the 
patient  must  not  be  exhausted,  and  if  weak  should  be  rubbed  during 
the  bath.  It  has  an  extended  field  of  action  in  some  of  the  most 
intractable  diseases  with  which  practitioners  have  to  contend,  such 
as  endocarditis,  valvular  insufficiency,  arterial  and  cardiac  stenosis, 
cardiac  dilation,  Basedow's  disease,  all  forms  of  motor  artd  sensory 
cardiac  neuroses,  and  finds  a  contraindication  only  in  conditions  m 
which  an  increased  arterial  pressure  would  be  dangerous,  such  as 
pronounced  arterio-sclerosis,  aneurism,  fatty  degeneration  and  angina 
pectoris  accompanied  with  sclerosis  of  the  coronary  arteries.  In  those 
cases  of  chronic  so-called  rheumatic  or  articular  disease  favorable 
results  have  been  obtained  from  the  use  of  these  baths.  The  author 
does  not  recommend  them  in  rheumatic  diseases,  unless  they  are 
complicated  by  organic  heart  disease.  Sometimes  the  gouty  and 
rheumatic  suffer  from  a  recrudescence,  but  this  is  usually  of  short 
duration.  Those  afflicted  with  chronic  pelvic  disease  of  a  congestive 
or  inflammatory  type  receive  marked  benefit  from  the  derivative  and 
metabolic  influences  produced  by  this  bath.  In  locomotor  ataxia  I  can 
confirm  the  praise  that  many  writers  give  to  this  bath;  it  is  certainly 
of  value.  It  may  be  used  as  a  half  or  full  bath,  and  during  its  use  the 
limbs  may  be  rubbed.  The  bath  is  contraindicated  in  acute  and  sub- 
acute inflammatory  diseases  of  the  spinal  cord. 


166  PRACTICAL  HYDROTHERAPY. 

Oxygen  Bath. 

Winternitz6  has  recently  studied  the  action  of  oxygen  instead  of 
carbon  dioxide  baths.  It  is  an  effervescent  bath,  the  action  of 
which  is  not  due  to  any  oxygen  absorption,  but  to  the  physical  and 
chemical  irritation  of  the  presence  of  oxygen  in  the  water,  in  the 
same  manner  as  the  carbon  dioxide  bath.  The  oxygen  bubbles  are 
smaller,  adhere  closer  to  the  surface  in  a  layer  between  the  skin  and 
water.  They  cause  a  pleasant  prickly  sensation,  and  alter  the  thermic 
impressions  arising  from  the  surface.  The  temperatures  are  the  same 
as  the  Nauheim  bath.  Baths  given  at  86°  F.  decreased  blood  pressure 
35  mm.  Hg.  while  in  the  bath,  and  twenty  minutes  after  the  bath  a 
further  drop  of  58  mm.  took  place.  At  97°  F.  the  pressure  was  low- 
ered 25  mm.,  but  before  the  end  of  a  ten  minute  bath  was  10  mm. 
above  pressure  at  beginning.  In  a  C02  bath  at  86°  F.  the  pressure 
was  reduced  35  mm.,  but  during  the  bath  began  to  rise,  and  one  hour 
later  was  only  10  mm.  lower  than  before.  Fresh  water  lowered 
pressure  20  mm.  during  and  increased  slightly  in  half  an  hour 
later.  The  best  temperature,  therefore,  to  reduce  blood-pressure  is 
86°  F.  The  relative  frequency  of  the  pulse  was  studied.  At  68°  F. 
the  pulse  was  reduced  by  fresh  water,  18;  by  O,,  12;  by  CCX,  12; 
at  97°  F.  fresh  water  reduced  8;  O,,  8;  CO,  2  beats.  Temperature 
supplemented  by  the  mechanical  and  chemical  action  of  the  gas  is 
most  important  in  affecting  blood  pressure.  Oxygen  bubbles  cause 
goose  flesh,  owing  to  the  rhythmical  contraction  of  the  cutaneous 
muscles.  This  increases  "Hutchinson's  peripheral  heart."  It  finds  its 
sphere  of  usefulness  in  high  blood  pressure,  cardiac  neuroses,  neuras- 
thenia and  cases  sensitive  to  low  temperatures.  Low  blood  pressure 
contraindicates. 

The  Full  Cold  Bath. 

This  is  one  of  the  most  powerful  of  all  hydriatic  procedures,  its 
use  being  practically  limited  to  acute  infectious  diseases.  It  is  known 
in  this  country  as  the  Brand  bath  or  "tubbing,"  acquiring  its  name 
from  its  originator,  Dr.  Ernest  Brand,  of  Stettin,  Germany.  When 
used  by  those  in  health  or  in  certain  non-infectious  diseases  its  action, 
aim  and  object  are  entirely  different  from  the  action  of  the  bath  in 
infectious  diseases,  and  are  described  under  the  head  of  the  "plunge 
bath."  The  tub  to  be  preferred  is  a  tin  one  capable  of  being  moved 
to  the  patient's  bedside.  It  should  be  at  least  six  and  a  half  feet  long 
by  two  and  a  quarter  feet  wide.  It  may  be  here  remarked  that  tubbing 
can  be  carried  out  in  the  country  as  well  as  in  the  city,  the  parapher- 
nalia needed  being  simple  and  easily  obtained.  Where  the  slightest 
ingenuity  is  exerted  the  object  can  easily  be  attained. 

In  hospital  practice  one  of  the  tubs  here  illustrated  will  be  found 

6  Winternitz,    Wm. :     Blaetter   f.    Klinische    Hydrotherapie,    January,    1907. 


Typhoid   Fever  Tub   (Bellamy's). 


Presbyterian  Hospital  Tub   (Oliver's). 


Platu  91— Portable  Bath  Tubs. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  167 

more  useful,  because  of  their  superior  durability  and  the  ease  of 
cleaning  them.  The  shape  of  the  tub  is  well  shown  in  the  diagram. 
It  is  fifty  inches  long  and  twenty-seven  inches  wide,  and  consists  of 
two  parts,  so  arranged  that  the  patient's  lower  extremities  are  bent 
at  right  angles  to  his  recumbent  body,  the  feet  resting  upon  a  double 
bottom  which  is  filled  with  hot  water.  The  latter  is  poured  into  the 
douche  bottom  through  a  tube  with  a  funnel-shaped  opening,  which 
is  secured  in  one  corner  of  the  tub ;  a  faucet  upon  the  posterior  aspect 
of  this  hot- water  receptacle  gives  exit  to  the  hot  water.  The  object 
of  this  tub  is  to  afford  the  patient  an  easy  recumbent  position  and 
prevent  the  cold  water  from  chilling  the  feet  and  producing  painful 
cramps  during  the  bath.  Its  short  and  compact  form  renders  it  more 
portable  than  the  ordinary  tub.  The  manufacturers7  have  con- 
structed the  bath-tub  of  highly  enameled  wood  and  lined  it  with 
tinned  copper,  thus  rendering  it  easily  cleaned.  The  height  of  the 
tub  saves  much  back  strain  to  the  nurses,  whose  constant  attention 
is  required  for  friction  during  the  continuance  of  the  bath.  Among 
the  best  portable  tubs  is  the  Coile.8  It  is  a  safe  and  efficient  means  of 
administering  the  Brand  bath,  especially  in  bed.  It  is  more  easily 
managed  in  private  homes  and  is  less  feared  by  patients.  It  is  a  full- 
sized  pneumatic  tub,  that  may  be  inflated  by  introducing  air  with  an 
ordinary  air  pump,  and  deflated  by  opening  the  air-escape  valve.  It 
is  made  of  rubber  fabric.  On  a  level  with  the  bottom  is  a  funnel 
sleeve  through  which  water  may  be  poured  into  or  removed  from  the 
tub.  The  entire  outfit — tub,  pump,  towels,  etc. — may  be  packed  for 
transportation  in  an  ordinary  suit  case  13x26  inches.  A  blanket  is 
first  spread  on  the  bed  and  the  tub  placed  on  top  of  it.  The  patient  is 
then  assisted  by  the  nurse,  who  first  gently  lifts  the  head  and 
shoulders,  then  the  hips  and  legs  onto  the  deflated  tub  (see  cut),  the 
walls  of  which  are  then  inflated  by  the  air  pump,  requiring  but  a 
minute.  The  water  at  proper  temperature  is  then  poured  in  and  the 
process  hereafter  to  be  described  carried  out  (see  cut).  When  com- 
pleted the  nurse  lowers  the  funnel  sleeve  into  a  suitable  vessel  on  the 
floor  by  the  bedside  and  the  water  quickly  flows  out.  At  the  same 
time  the  air  is  allowed  to  escape  from  the  valve,  allowing  the  tub  to 
collapse.  The  patient  is  now  removed  from  the  tub  upon  the  blanket 
(see  cut). 

Ordinarily  after  the  tub  has  been  secured  a  piece  of  oil  cloth, 
carpet  or  other  protective  of  sufficient  size  is  placed  on  the  floor  by 
the  bedside  in  order  to  protect  the  floor  or  carpet.  The  tub,  with 
its  head  at  the  foot  of  the  patient's  bed,  is  then  placed  on  two  low 
stools  or  wooden  rests  so  as  to  bring  its  rim  on  a  level  with  the 
patient's  bed.       It  should  be  separated  from  the  patient's  bed  by  a 

7  Kny-Scheerer  Co.,   224  Fourth  Avenue,   New  York  City. 

8  Coile   Bed  Bath   Co.,   Knoxville,  Tenn. 


168  PRACTICAL  HYDROTHERAPY. 

screen.  Several  towels,  a  sheet,  and  a  napkin  should  be  at  hand. 
The  tub  is  now  filled  with  water  to  a  depth  sufficient  to  cover  the 
patient,  at  a  temperature  ranging  from  85°  to  65°  F.  Where  possible 
the  tub  should  be  partly  filled  with  water  outside  the  patient's  room, 
the  correct  temperature  being  secured  by  the  addition  at  the  bedside 
of  water  either  hot  or  cold.  Every  effort  is  made  to  make  as  little 
disturbance  as  possible  and  all  excitement  must  be  promptly  elimin- 
ated. A  double  blanket  is  spread  on  the  bed  to  be  occupied  by  the 
patient;  over  this  is  placed  a  dry  and  soft  linen  sheet  and  the  pillow 
or  bolster  covered  with  a  crash  towel.  Everything  being  in  readiness, 
the  patient  receives  a  stimulant.  This  one  point  of  a  stimulant  is 
much  opposed  by  some  who  use  the  full  Brand  bath ;  the  author  be- 
lieves in  its  use  only  in  emergencies.  The  night  dress  or  night  gar- 
ments are  removed  and  the  sexual  organs  protected  by  a  napkin.  The 
face  is  now  bathed  in  cold  water  (50°  F. ),  and  a  cold  wet  turban 
placed  on  the  head.  There  should  be  no  evidence  of  faint-heartedness 
or  lack  of  confidence  in  the  application  of  this  bath  by  the  nurse  or 
physician,  should  he  be  a  bystander,  and  it  is  a  good  rule  for  the  phy- 
sician to  always  be  present  at  the  first  bath.  All  members  of  the  fam- 
ily must,  if  possible,  be  excluded  from  the  room.  The  patient  is  now 
gently  lifted  from  the  bed  and  placed  in  the  bath.  The  first  impres- 
sion is  exceedingly  disagreeable,  and  he  is  apt  to  gasp  and  shrink  from 
its  further  use.  He  must  be  encouraged  and  reassured  both  by  word 
and  action,  for  an  entire  absence  of  haste  and  fussiness  will  do  much 
to  overcome  his  very  acute  desire  to  be  let  off  from  what  he  will 
term  severe  treatment.  Here,  as  in  many  of  the  positions  in  which 
a  physician  is  placed,  tact  will  accomplish  wonders.  My  observa- 
tion, however,  leads  me  to  believe  that  the  family  are,  as  a  rule, 
more  difficult  to  manage  than  the  patient,  as  they  are  usually  strangers 
to  cold  water  in  their  daily  ablutions,  and  share  with  the  patient  the 
feeling  of  repulsion.  As  soon  as  the  patient  is  immersed,  the  nurses 
commence  to  gently  rub  or  chafe  the  entire  body,  rubbing  the  different 
parts  successively,  but  avoiding  the  lower  abdominal  region.  Too 
great  stress  cannot  be  placed  upon  the  need  for  this  rubbing,  and  its 
careful  and  continued  use  during  the  bath  is  the  one  absolutely  neces- 
sary feature  to  success.  Brand  truly  states  that  by  its  use  collapse, 
cyanosis  and  heart  failure  are  prevented,  and  this  is  readily  believed 
by  those  who  have  used  the  bath  and  seen  the  redness  that  follows 
its  application.  Under  the  influence  of  cold  and  friction  there  is  a 
contraction  and  dilatation  of  the  peripheral  blood-vessels,  and,  as 
we  shall  see  later,  this  enhances  heat  abstraction.  Xo  attention  should 
be  paid  to  a  small  pulse,  to  complaints  of  chilliness,  to  a  shrivelled 
condition  of  the  skin  of  the  hands  and  fingers,  for  these  do  not  de- 
mand cessation  of  the  bath,  but  care  and  attention  should  be  given  to 
the  face,  especially  the  lips,  and  if  cyanosis  occurs  it  is  due  to  en- 


Plate  92 — Patient  in  Deflated  Tub. 


Plate  93 — Inflating  the  Tub. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  169 

feebled  heart  action;  for  the  face,  being  free  from  the  local  action 
of  the  cold  water,  is  a  true  index  of  a  cyanosis  due  to  the  lack  of 
cardiac  action.  Should  this  occur,  the  hath  must  he  discontinued  and 
the  patient  removed.  In  the  use  of  the  next  bath  more  attention  must 
be  paid  to  friction,  for  it  may  be  taken  as  a  good  rule  that  where 
friction  is  well  applied  no  such  result  is  to  be  expected.  During  the 
bath  the  turban  on  the  patient's  head  must  be  re-wet.  The  tempera- 
ture at  which  the  bath  is  administered  is  usually  65°  F.,  but  it  is  a  good 
plan  to  commence  at  85°  to  90°  F.  and  reduce  each  hath  from  three 
to  five  degrees  until  65°  F.  is  reached,  at  which  point  the  temperature 
is  maintained.  The  duration  of  the  bath  is  usually  fifteen  minutes, 
but  here  again  it  is  also  a  good  plan  to  commence  with  five  to  seven 
minutes  and  lengthen  the  time  as  the  temperature  of  the  water  is 
lowered.  It  must  be  again  reiterated  that  friction  is  the  element  to 
watch,  making  it  as  vigorous  as  the  patient  will  stand.  The  patient 
should  not  be  removed  during  the  primary  reaction,  as  the  aim  in  this 
bath  is  not  to  secure  ordinary  hydrothcrapentic  reaction.  The  bath 
being  finished,  the  patient  is  lifted  out  of  the  tub  and  placed  on 
the  prepared  bed,  the  napkin  dropped  from  the  pelvic  region,  rapidly 
covered  with  the  dry  linen  sheet,  the  folds  of  which  are  pressed  be- 
tween the  arms  and  the  body  and  between  the  lower  limbs.  The 
blanket  is  then  wrapped  around  the  body  and  hot-water  bottles  placed 
to  the  feet,  which  are  usually  cold.  The  wet  turban  is  now  removed 
from  the  head.  The  patient's  hair  is  dried  while  he  lies  from  five  to 
ten  minutes  in  the  sheet  and  blanket.  He  is  then  to  be  gently  dried 
with  towels,  the  night  dress  put  on,  the  blanket,  sheet,  etc.,  removed, 
and  covered  lightly  with  the  bedclothing.  If  the  bath  is  successful, 
the  patient  is  quiet,  comfortable  and  usually  falls  asleep.  If  he  is 
restless,  is  uncomfortable  and  shivers,  the  technique  is  inaccurate  and 
points  to  a  change  in  the  temperature,  duration  or  friction,  especially 
the  latter.  The  hot-water  bottle  should  be  allowed  to  remain  only  a 
few  moments,  as  it  is  unnecessary,  and  usually  becomes  needless 
after  a  few  baths. 

Physicians  and  others  who  have  been  subjected  to  both  varieties 
of  baths  ciaim  that  the  sudden  immersion  into  the  coldest  temperature 
required  is  far  less  unpleasant  and  chilling  than  the  gradually  reduced 
bath.    The  latter  is  certainly  more  fussy  and  troublesome. 

"The  Ziemssen  graduated  bath  belongs  also  in  this  category. 
Ziemssen  has  the  patient  sit  in  a  bath  the  temperature  of  which  is 
5°  or  6°  C.  (68°  F.)  in  the  course  of  ten  or  fifteen  minutes.  The 
duration  of  the  entire  bath  is  from  twenty  to  thirty  minutes,  until  the 
patient  ceases  to  shiver  in  spite  of  vigorous  frictions  and  af- 
fusion. He  is  then  removed  and  placed  in  a  previously  warmed  bed. 
The  bath  is  far  more  efficacious  in  its  antipyretic  effect  than  the  cool 
baths  of  short  duration.  There  will  be  observed  a  decline  in  the  tem- 
perature of  so  much  as  2J/2°  C.   (4.5°  F.),  but  the  stimulating  influ- 


170  PRACTICAL  HYDROTHERAPY. 

ence  upon  the  vascular  and  the  nervous  systems  is  wanting,  and  depres- 
sion is  often  more  serious  than  even  a  considerable  elevation  of  tem- 
perature." ° 

Physiological  Action  of  the  Full  Cold  Bath. — Before  we  consider 
in  detail  the  action  of  the  Brand  bath  (full  cold  bath  with  friction), 
it  is  well  to  first  take  up  the  part  played  by  friction.  As  has  been 
shown  heretofore,  its  application  produces  a  stimulation  of  the  cu- 
taneous blood-vessels,  that  dilate  under  its  use,  so  that  a  large  quantity 
of  blood  is  made  to  traverse  the  skin,  which  in  this  instance  gives  a 
larger  radiating  surface  for  heat  abstraction  and  cooled  blood  ex- 
changed for  warmer.  By  the  prevention  of  tremor,  muscular  con- 
tractions, both  tonic  and  clonic,  are  eliminated,  and  one  of  the  means 
of  heat  compensation  checked ;  thus  production  of  heat  is  prevented 
at  the  same  time  that  the  cold  water  abstracts  greater  heat;  for,  as 
Pospischl  has  shown,  mechanical  irritation  of  the  skin  decidedly  in- 
creases heat  loss,  which  increase  he  placed  at  as  much  as  95  per  cent. 
With  this  preamble  we  are  ready  to  consider  its  action  upon  circulation. 

As  soon  as  immersed,  contraction  of  the  superficial  tissues  takes 
place,  especially  the  blood-vessels,  and  accompanied  by  tremor.  These 
blood-vessels  would  remain  contracted  during  the  entire  bath  were  it 
not  for  the  friction.  When  faithfully  performed,  the  skin  takes  on  a 
pinkish  hue,  showing  that  the  cutaneous  circulation  is  more  active, 
and  that  the  column  of  blood  driven  from  the  surface  to  the  interior 
by  the  first  impact  of  the  water  has  returned  to  the  periphery.  As  a 
resultant,  the  interior  is  drained,  and  the  movement  of  the  blood  made 
more  active  as  well  as  perfect.  The  pulse  is  slowed,  its  tension  raised, 
and  while  smaller  during,  becomes  much  larger  after  the  bath.  Sphyg- 
manometric  measurements  show  an  increase  in  arterial  tension.  The 
thermic  and  other  impressions  arising  in  the  periphery  are  conveyed 
to  the  central  nervous  system,  and  from  the  governing  centers  therein 
are  reflected  upon  the  cardiac  mechanism,  as  a  result  of  which  toning 
and  refreshing  influences  are  brought  about,  which  in  turn  stimulate 
the  cardiac  muscle,  energizing  it,  increasing  the  force  of  its  contractions, 
lessening  their  number,  producing  a  pulse  that  seems  small,  though  its 
tension  is  improved  and  it  possesses  increased  force.  Two  conditions 
result — obstruction  at  the  periphery  is  removed,  and  a  vis  a  fronte 
encouraged,  while  the  stronger  contractions  of  the  heart  increase  the 
vis  a  tcrgo,  a  favorable  state  of  the  circulation  under  any  circum- 
stances. It  should  be  borne  in  mind  that  these  influences  upon  the 
pulse,  heart  and  circulation  do  not  immediately  pass  away,  but  grad- 
ually subside  between  baths.  A  failure  to  appreciate  the  effect  of  the 
constrictive  action  of  cold  upon  the  peripheral  vessels  has  led  many 
to  find  fault  with  the  full  cold  bath  in  the  treatment  of  febrile  condi- 
tions.    Again  I  state,  friction  is  the  keynote  of  success. 

9   Strasser,    A.:    "Hydrotherapy,"    Vol.    IX,    Cohen's   Physiological   Therapeutics. 


Plate  94 — Nurse   Applying  Friction 


Plate  95 — Drawing  Off  the  Water 


THE  TECHNIQUE  OF  HYDROTHERAPY.  171 

Upon  the  temperature  this  bath  has  a  most  noticeable  and  impres- 
sive effect,  but  one  should  here  again  interpose  and  state  that  the 
reduction  of  temperature  is  not  the  sole  aim  of  the  bath,  as  so  many 
physicians  imagine.  Temperature  and  the  specific  typhoid  germ  are 
not  so  dangerous  themselves  as  are  generally  supposed ;  in  fact,  many 
now  believe  a  moderate  range  of  fever  is  beneficial  in  infectious  dis- 
eases.  The  danger  arises  from  two  sources — the  typho-toxins  and 
those  metabolic  poisons  that  arise  from  the  pathological  tissue  state 
incident  to  the  disease.  While  the  bath  first  causes  contraction  of  the 
superficial  tissues  and  tremor,  associated  with  a  transient  rise  in  tem- 
perature, the  friction  overcoming  this,  and  producing  a  marked  dila- 
tation of  the  blood-vessels  of  the  surface,  we  now  have  all  the  factors 
aiding  in  heat  loss.  The  body  being  immersed  in  the  cold  medium, 
with  a  large  area  of  blood  exposed  to  its  action,  gives  up  its  heat  to 
the  surrounding  water,  while  heat  generation  is  prevented  by  the 
elimination  of  tremor  or  muscular  activity.  This  loss  is  somewhat 
proportional  to  the  dilated  state  of  the  blood-vessels,  for,  as  has  been 
shown  by  Traube,  a  rise  in  temperature  is  usually  due  to  a  con- 
traction of  the  blood-vessels,  and  that  the  maximum  rise  of  tempera- 
ture is  coincident  with  their  maximum  contraction ;  hence  it  is  that  the 
effect  of  this  bath  upon  the  circulation  above  described  is  to  eliminate 
two  of  the  principal  features  in  the  prevention  of  heat  elimination. 
Reflexly,  the  contracted  internal  vessels  prevent  visceral  heat  gen- 
eration. The  blood,  after  giving  up  its  heat,  is  pushed  by  the  toned 
circulation  into  the  interior,  and  bathing  the  thermogenic  centers  in 
a  cooler  medium  favors  heat  elimination  and  lessens  heat  generation, 
while  the  superheated  visceral  blood  is  driven  to  the  surface.  Reduc- 
tion of  temperature  follows. 

Upon  the  nervous  system  is  to  be  found  the  greatest  good  and  most 
enduring  action  of  the  full  cold  bath.  In  the  majority  of  febrile  in- 
fections, be  they  due  to  specific  micro-organisms  or  otherwise,  their 
influence  becomes  noticeable  at  once  upon  this  important  mechanism 
of  the  human  body,  and  it  is  not  long  before  it  shows  a  deprecia- 
tion in  tone  that  is  doubtless  due  to  the  toxin  of  the  specific  morbific 
agent.  We  find  that,  as  a  rule,  malaise  and  partial  exhaustion  present, 
which,  when  followed  to  the  ultimate  end,  simply  mean  the  fore- 
runner of  coma,  delirium,  stupor,  subsultus,  etc.;  sleep  restless,  dull 
headache,  and  a  general  hardly  definable  nervous  unrest  and  discom- 
fort, very  trying  to  most  cases.  Mental  function  is  much  diminished, 
the  expression  is  apathetic ;  all  the  ordinary  nervous  functions  dimin- 
ish in  activity.  This  is  usually  the  condition  of  affairs  when  the  pa- 
tient is  seen  with  a  fully  developed  febrile  attack.  All  will  probably 
admit  that  the  greatest  danger  lies  in  the  overwhelming  of  the  ner- 
vous system  by  these  poisons,  and  that  too  great  care  cannot  be  taken 
to  prevent  their  evil  effects.     It  has  been  maintained  bv  those  who  are 


172  PRACTICAL  HYDROTHERAPY. 

far  more  competent  than  myself  to  speak,  that  the  essential  point  in 
the  conduct  of  such  cases  is  the  maintenance  of  the  patient's  neural 
vitality  until  the  poison  of  the  affection  can  he  eliminated.  While 
this  is  in  a  certain  sense  true,  still  it  is  not  all  that  is  necessary.  I  think 
it  will  be  found  upon  close  insvestigation  that  the  full  cold  bath  comes 
nearer  to  meeting  all  the  requirements  of  each  observer  than  any  other 
single  therapeutic  weapon  that  can  be  wielded.  When  we  come  to 
study  the  influence  of  the  full  cold  bath  upon  the  nervous  system  in 
febrile  diseases,  we  find  that  all  the  conditions  mentioned  above  are 
promptly  met,  and  that  its  application  with  friction  arouses  into  ac- 
tion all  the  peripheral  nerve  endings,  impressions  from  which  are  con- 
veyed to  the  great  centers,  a  thousand  reflex  influences  started,  that  are 
shunted  to  every  nook  and  cranny  of  the  central  nervous  system,  with 
the  result  that  this  mechanism  is  aroused  from  its  lethargy  and  stim- 
ulated to  throw  off  the  dominating  and  paralyzing  influence  of  the 
acute  toxins.  The  eye  no  longer  appears  apathetic,  but  brighter; 
the  mind  clears  up  and  responds  more  promptly;  reflected  effects  are 
shown  in  every  function  of  the  viscera,  and  varied  influences  travel 
to  the  end  of  every  nerve  fiber  of  this  governing  and  dominant  sys- 
tem, so  that  its  dynamic  power  is  aroused  to  fight  the  battle  and  main- 
tain its  integrity.  It  is  largely  because  of  these  effects  upon  the  central 
nervous  system  that  hydriatists  maintain  that  the  Brand  bath,  when 
properly  applied,  accomplishes  more  than  any  known  medicinal  rem- 
edy upon  temperature,  circulation  and  the  nervous  system. 

Upon  respiration  the  first  effect  of  the  cold  bath  is  to  cause  gasping 
and  a  sense  of  disagreeable  constriction  about  the  chest.  Respira- 
tion is  increased  during  the  application  of  the  bath  itself,  and  is,  as 
a  rule,  shallower  than  normal.  Observations  made  upon  this  function 
show  that  in  febrile  diseases,  as  a  rule,  both  the  amount  of  oxygen 
inhaled  and  absorbed,  and  carbon  dioxide  exhaled  and  eliminated. 
are  markedly  diminished.  Immediately  upon  the  removal  of  the  pa- 
tient from  the  bath,  the  respiration  usually  returns  to  the  normal,  and 
is  fuller  and  deeper  than  before  the  application.  There  is  a  greater 
amount  of  absorbed  oxygen  and  a  greater  amount  of  exhaled  carbon 
dioxide,  showing  that  this  bath  simply  bears  out  the  general  hydro- 
therapeutic  effects  of  cold  baths  properly  applied,  viz.,  that  there  is 
a  marked  increase  of  oxidative  processes  taking  place  in  the  body, 
and  this  we  would  expect,  particularly  in  view  of  the  circulatory 
changes.  Energizing  muscular  tissues,  as  the  Brand  bath  does,  we 
find  that  the  amplitude  of  respiration  is  enhanced,  which  of  itself  acts 
like  a  pump  in  moving  the  blood  through  the  pulmonary  and  general 
circulation,  relieving  stasis  and  hypostatic  congestion,  as  well  as  aiding 
in  the  better  removal  of  mucus  in  the  bronchioles.  It  is  almost  need- 
less to  remark  that  a  better  oxygenized  blood  destroys  toxins,  specific, 
metabolic  and  auto-toxic. 


Plate  96 — Drying   Patient. 


Plate  97 — Removing  Tub. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  173 

Upon  metabolism,  febrile  disturbances,  as  a  rule,  prove  quite  a  dis- 
turbing factor.  The  entire  economy  is  combating  witb  a  specific  toxin, 
the  effect  of  which  upon  the  tissue  is  most  marked,  producing  degen- 
eration. The  glandular  system  of  the  body,  especially  the  liver,  in 
its  endeavor  to  throw  off  this  poison,  is  particularly  prone  to  be  af- 
fected, and  its  failure  to  act  profoundly  influences  the  metabolic 
processes  of  the  body.  All  secretions  of  the  glands  of  the  gastro- 
intestinal tract  are  diminished  in  quantity  and  quality.  As  these  se- 
cretions digest  food  and  maintain  intestinal  activity,  their  absence  or 
decrease  means  the  development  in  the  intestine  of  certain  bacterial 
flora,  the  coli  and  putrescent  ones,  which  add  another  factor  to  the 
already  overburdened  and  toxic  system.  Within  the  tissues  oxidative 
processes  are  reduced  to  a  low  level,  so  that  toxic  material  of  a  kata- 
bolic  character  accumulates,  being  incapable  of  removal  because  of 
a  weakened  circulation  and  diminished  elimination.  With  a  more 
active  circulation,  with  a  rise  in  blood  pressure,  these  toxins  are  pushed 
out  of  the  liver  and  other  tissues,  glandular  action  is  stimulated,  the 
tongue  clears,  sordes  lessens,  appetite  improves,  digestive  power  is 
regained.  With  the  respiratory  activity  and  oxygen-absorption,  oxi- 
dative processes  take  place,  destroying  the  waste  tissue  material  and 
toxins,  or  converting  them  into  harmless  soluble  end-products  capable 
of  easy  removal.  Nutrition  is  of  necessity  enhanced,  and  degenera- 
tive processes  prevented,  especially  if  the  bath  is  used  from  the  start. 
This  improved  state  of  tissue  is  particularly  well  shown  in  the  im- 
proved state  of  the  skin  and  its  glandular  structures,  which  changes 
from  its  sallow,  dry,  harsh  and  inactive  state,  and  becomes  white, 
moist,  elastic  and  soft. 

Upon  elimination  the  action  of  this  bath  is  specific.  The  febrile 
state  causes  a  diminution  of  the  action  of  all  glandular  structures  that 
preside  over  this  function,  it  being  especially  noticeable  in  typhoid 
in  the  secretion  of  the  kidney  and  skin.  The  quantity  of  the  urine 
steadily  diminishes,  and  assumes  its  characteristic  dark  color,  turbid 
appearance  and  disagreeable  smell,  while  its  toxic  power  rapidly  rises 
until  it  is  several  times  as  toxic  as  normal  urine.  The  first  noticeable 
effect  upon  this  excretion  is  an  increase  of  volume,  although  little 
change  in  appearance  takes  place.  Shortly,  however,  it  more  nearly 
assumes  the  normal,  and  its  increased  volume  may  be  maintained, 
as  much  as  fifty  to  sixty  ounces  being  passed  in  twenty-four  hours. 
This  is  due  not  to  the  increased  water  drinking,  as  some  suppose,  but 
to  a  better  vasomotor  tone  and  rise  in  blood  pressure.  The  better  puri- 
fication of  the  blood  stream  by  the  more  active  kidney  reacts  upon 
every  function  and  tissue  of  the  body,  for  just  in  proportion  to  the 
lessening  of  toxins  will  the  general  danger  to  the  patient  diminish. 
The  skin  of  a  febrile  patient  has  a  peculiar  feeling  to  the  touch,  and 
appears    dry,    dirty,   harsh   and   inactive.      Its   blood-vessels    are   con- 


174  PRACTICAL  HYDROTHERAPY. 

tracted,  large  masses  of  epithelial  cells  collect  on  the  surface,  the 
glands  act  little  and  their  secretion  is  quickly  dried.  Its  vicarious 
function  in  states  of  toxemia  has  been  pointed  out  by  Bouchard,10  but 
this  is  in  abeyance.  Immersion  in  the  cold  bath,  accompanied  by  fric- 
tion, Upon  producing  the  vascular  changes  enumerated,  resumes  its 
activity.  The  softening  effect  of  the  water  and  the  mechanical  re- 
moval of  the  dead  epithelium  and  inspissated  excretions  give  the 
glandular  structures  an  opportunity  to  eliminate  both  bacteria  and 
toxins.  The  skin  gradually  becomes  softer,  more  pliable  and  elastic, 
loses  its  dingy,  dirty  appearance,  becomes  white  and  pleasant  to  the 
touch.  As  the  glands  act  more  freely  a  slight  moisture  appears,  fa- 
vorable to  elimination  as  well  as  to  heat  loss. 

Upon  the  blood,  as  we  have  previously  shown,  cold  baths  act  bene- 
ficially. In  febrile  states  the  number  of  corpuscles,  both  red  and 
white,  are  not  only  diminished,  but  rendered  less  active  both  in  their 
oxygen-carrying  and  bactericidal  power.  YVinternitz  and  Thayer11 
have  shown  that  the  cold  bath  not  only  increases  markedly  the  number 
of  red  blood  cells  in  the  circulation  and  their  oxygen-absorbing  and 
carrying  power,  but  that  this  is  true  in  typhoid  as  in  health.  The  in- 
teresting iole  that  the  leucocytes  play  in  their  phagocytic  capacity  is 
diminished  or  obtunded  in  infectious  fevers,  but  the  stimulating  effect 
of  the  cold  bath  rouses  them  from  their  lethargy,  increases  their  num- 
ber and  power  to  battle  with  the  invading  host.  The  enemy  are  met 
and  checked,  even  if  they  are  not  completely  routed.  Breitenstein12 
found  in  twenty-nine  cases  that  there  was  an  increase  of  at  least  fifty 
thousand  red  cells  to  each  cubic  millimeter,  which  was  accompanied 
by  a  corresponding  increase  of  hemoglobin. 

In  conclusion,  it  may  be  said  that  the  cold  full  bath  of  Brand  rouses 
the  nerve  centers,  sustains  vital  power,  stimulates  respiration  and  oxi- 
dation, increases  elimination,  energizes  the  heart,  improves  the  pulse, 
raises  arterial  tension,  thereby  toning  the  circulation  through  the  vase- 
motors;  purifies  the  blood,  reduces  temperature,  prevents  compli- 
cations and  makes  the  patient  more  comfortable.  This  bath  should 
never  be  administered  when  the  patients  are  very  old.  to  infants,  when 
hemorrhage  is  threatened,  when  the  temperature  is  subnormal,  in  the 
eruptive  fevers,  pneumonia,  nephritis,  or  inflammations  of  the  visceral 
organs  of  abdomen  or  pelvis. 

The  therapeutic  action  of  the  Brand  full  bath  is  practically  limited 
to  the  treatment  of  severe  febrile  manifestations,  of  which  typhoid 
fever  is  the  type,  and  for  the  treatment  of  which  Brand  originated 
the  bath.  When  we  come  to  consider,  in  the  therapeutic  portion  of 
this  work,  the  question  of  the  treatment  of  typhoid  fever,  this  sub- 
let Bouchard,   C. :     "Auto-toxemia." 

11  Loc.    cit.,    p.  4-v  — 

12  Archives   f.    Experiment.    Pathclogie    und    Pharmakologie,     Baid  32,    1896. 


'■'"r-'^KH 


Plate  97a — Plunge  Bath. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  175 

ject   will  be  taken  up  in  detail,  and  therefore  will  not  be  mentioned 
here. 

The  Cold  Plunge  Bath. 

This  bath  is  usually  administerd  with  an  ordinary  bath-tub  of  suf- 
ficient length  to  permit  of  the  patient's  reclining  comfortably  with 
the  shoulders  well  covered  by  the  water.  The  best  tub,  of  course, 
is  the  porcelain-lined  tub  of  good  width  and  fully  seven  and  a  half 
feet  long.  It  may  also  be  administered  in  institutions  in  a  water-tight 
tank  with  a  depth  of  about  five  feet.  It  is  customary  in  these  institu- 
tions to  have  one  end  of  the  tank  with  steps  so  that  the  patient  can 
either  walk  or  plunge  into  the  bath  and  walk  out.  The  tub  should  be 
tilled  with  water  ranging  from  50°  to  65°  F.,  the  duration  in  brief 
ranging  from  one- fourth  to  one-half  minute.  The  plunge  bath  should 
not  be  used  save  by  those  who  are  in  excellent  and  robust  health,  and 
never  be  entered  when  the  skin  is  cold  or  chilly.  The  body  must  be 
well  warmed,  either  by  some  brief  hot  application,  such  as  a  warm 
bath,  dry  hot  air,  electric  light  bath,  Turkish  bath,  or  exercise.  The 
cold  plunge  is  often  taken  in  the  morning  as  a  stimulant  by  the  robust. 
The  best  effects  are,  in  my  opinion,  derived  from  a  very  sudden  immer- 
sion of  great  brevity.  It  is  best  to  at  once  "plunge"  into  the  bath, 
immersing  the  head,  as  by  so  doing  the  sensation  of  cold  is  far  less 
noticeable  and  much  less  disagreeable  than  when  slowly  entered. 
Ten  to  fifteen  seconds  is  ample  for  the  average  plunge,  although  some 
writers  recommend  it  for  a  period  of  even  two  minutes.  During  the 
bath  the  patient  should  rub  himself  vigorously  or  use  swimming 
movements.  Immediately  upon  emerging  he  is  wrapped  in  a  Turkish 
sheet  and  vigorously  rubbed  until  dry.  It  is  essential  to  state  here 
that  vigorous  reaction  must  be  secured  or  the  bath  is  a  failure,  with 
distressing  and  depressing  effects. 

The  physiological  action  of  the  cold  plunge  bath  is  that  of  a  pow- 
erful excitant  measure,  and  for  that  reason  should  never  be  indulged 
in  by  the  weak  or  by  those  who  have  any  heart  disease  either  of  a 
functional  or  organic  character.  The  sudden  impact  of  the  body  with 
cold  water  at  this  low  temperature  produces  a  powerful  stimulation 
and  refreshing  effect  upon  the  nervous  system,  quite  similar,  in  a 
general  way,  to  the  action  described  in  the  Brand  bath.  Upon  the 
heart  and  circulation  this  bath  adds  quite  a  considerable  strain,  as 
the  blood  suddenly  leaving  the  periphery  congests  all  the  internal 
organs.  It  has  little,  if  any,  temperature-reducing  influences,  being 
too  short  in  its  duration.  The  reaction  following  the  cold  plunge  is 
probably  the  most  active  of  all  hydriatic  measures.  The  therapeutic 
indications  of  the  plunge  are  few.  The  author  wishes  to  enter  a  strong 
protest  against  the  custom,  that  is  prevalent  with  many  general  prac- 
titioners, of  ordering  the  cold  plunge   for  nervously  exhausted  and 


1/6  PRACTICAL  HYDROTHERAPY. 

run-down  patients.  To  say  the  least,  it  shows  a  total  ignorance  of 
the  action  of  this  bath  and  a  lively  disregard  of  the  dangers  attendant 
upon  its  use  in  these  cases. 

Surf  Bathing. 
This  form  of  hydriatic  procedure  is,  as  a  rule,  limited  to  those 
who  can  reach  the  seaside,  and  is  rarely  indulged  in  unless  the  water 
is  warm  and  pleasant.  On  the  Eastern  coast  the  time  of  year  varies 
with  the  latitude,  and  this  is  equally  true  of  the  Pacific  coast,  bathing  at 
some  places  in  Southern  California  and  Florida  being  available  during 
the  winter  months.  To  the  strong  and  vigorous  sea  bathing  is  one  of 
the  most  delightful  and  invigorating  of  all  aquatic  sports.  It  possesses 
a  delightful  esthetic  side,  that  enhances  the  pleasure  materially.  A 
fine  beach,  brilliant  sunshine,  bright  costumes,  the  roar  and  rush,  the 
splash  and  dash  of  the  oncoming  "white  caps,"  all  promise  exhilarating 
participation,  calculated  to  elevate  the  spirits  and  increase  the  activity 
of  the  circulation.  Chemically,  the  ocean  is  a  strong  solution  of  com- 
mon salt,  the  following  being  an  analysis  of  its  water : 

Chloride    of    sodium    25.1 

Chloride  of  potassium 5 

Chloride  of  magnesium 3.5 

Sulphate  of  magnesium  5.78 

Sulphate  of  lime 15 

Carbonate  of  magnesium 18 

Carbonate  of  lime 02 

Carbonate  of  potassium 23 

Iodides  and  bromides    traces 

Organic    matter   traces 

Water 964.54 

Total    1,000 

The  bather,  dressed  in  a  thin  bathing  attire,  with  a  preliminary 
promenade  in  the  warm  sun,  plunges  into  the  rapidly  moving  water, 
subjecting  the  cutaneous  surface  to  the  stimulating  influence  of  the 
waves.  It  will  readily  be  seen  that  we  have  here  combined  the  influ- 
ence and  effect  of  a  percutient  hydriatic  application,  and  it  is  not  far 
amiss  to  say  that  surf  bathing  closely  resembles  the  douche.  The 
author  is  such  a  firm  believer  in  the  many  advantages  to  be  derived 
from  the  use  of  surf  bathing  that  he  feels  a  few  words  are  essential 
for  the  government  of  those  who  prescribe  and  use  this  bath.  The 
water  usually  ranges  from  60°  to  75°  F. ;  the  maximum  duration 
should  be  approximately  twenty  minutes.  It  has  been  my  personal 
observation  that  the  action  of  the  bath  is  materially  enhanced  by 
dividing  the  time  of  immersion  with  intervals  spent  upon  the  beach 
in  the  sunshine  and  in  active  exercise.  By  the  repetition  of  short 
"dips"  in  the  ocean,  extending  altogether  possibly  over  three-fourths 
of  an   hour's   duration,   all   the   influences   that  go  to  make  up  surf 


T! 


x 


THE  TECHNIQUE  OF  HYDROTHERAPY.  177 

bathing  arc  more  satisfactory  and  active  in  their  effects.  Here,  again, 
we  must  not  lay  all  the  values  that  are  derived  to  surf  bathing  alone, 
for  we  have  the  very  best  and  purest  of  air,  brilliant  sunshine,  toning 
and  enhancing  every  tissue  and  function.  Associated  with  this  are 
the  physical  activity  of  the  body  and  the  swimming  in  the  water. 
Those  who  live  in  towns,  away  from  the  seashore,  have  always  seemed 
to  me  to  be  more  especially  benefited  by  surf  bathing  and  its  concomi- 
tants  than  those  who  reside  at  or  near  the  seashore.  To  the  man 
and  woman  living  in  large  cities,  cooped  up  the  better  part  of  the 
year  in  ill-ventilated  and  poorly  lighted  offices,  whose  skins  are  inactive 
and  leathery,  whose  digestion  is  weak,  whose  nervous  system  is  let 
down,  there  is  nothing  equal  to  even  a  short  sojourn  of  two  weeks  at 
the  seashore,  daily  battling  with  the  active  surf.  To  these  it  is,  as 
near  as  possible,  happiness  unrestrained,  with  the  joy  of  air  and  earth 
and  water,  with  the  absence  of  conventionalities  and  all  the  latitude 
that  comes  with  it.  This  return  to  the  wild  and  savage  life,  where 
the  skin  is  exposed  to  the  sun's  rays  and  to  the  cold  waves,  produces 
a  wild  exhilaration  that  starts  anew  the  bounding  impulses  of  life, 
and  brings  again  to  the  system  that  vigor  and  elasticity  that  should 
be  the  heritage  of  health  and  youth.  It  is  just  such  return  to  "Na- 
ture's own"  that  enables  the  denizen  of  the  densely  populated  centers 
to  return  again  to  the  battling  and  struggling  necessities  of  life.  If 
the  individual  is  strong  and  powerful  it  simply  renovates  and  recre- 
ates; if  anemic  and  run  down,  it  restores;  if  weakly,  it  strengthens. 
Even  in  robust  individuals,  however,  but  one  bath  should  be  taken 
daily,  and  in  surf  bathing,  as  in  all  other  hydriatic  procedures  of  a 
tonic  character,  the  writer  believes  it  should  be  taken  before  3  p.m., 
always  on  an  empty  stomach,  or  certainly  not  until  two  hours  have 
elapsed  since  eating.  It  is  an  excellent  plan  to  arrange  the  bath  so 
that  upon  leaving  the  surf  the  bather  can  go  directly  after  robing  to  his 
lunch.  The  bather  must  avoid  entering  the  ocean  while  the  body  is 
fatigued  or  chilled,  and  where  the  reactive  power  is  poor  the  plunge 
in  the  surf  should  be  of  very  short  duration,  not  exceeding  a  minute 
or  two,  followed  by  slow  walking  in  the  sun  and  exercise  movements 
of  the  arms.  If,  after  dressing  from  such  a  bath,  a  genial  glow  suf- 
fuses itself  over  the  sensitive  surface  of  the  body  and  is  succeeded 
by  a  pleasing  warmth  internally,  accompanied  by  a  refreshed  and  in- 
vigorated feeling,  it  is  evidence  and  proof  of  the  salutary  influences; 
but  if,  instead,  there  follow  a  chilliness,  languor,  headache,  irresistible 
depression  and  disposition  to  drowsiness,  or  any  of  these,  it  should 
be  reckoned  as  important  evidence  that  the  bath  has  not  contributed 
in  any  material  way  to  the  advantage  or  improvement  of  the  person's 
health,  and  that,  if  persisted  in  under  similar  or  like  conditions,  the 
result  will  in  time  prove  injurious.  If  these  precautions  are  observed, 
both  by  the  vigorous  and  sickly,  much  can  be  gained  from  a  course 


178  PRACTICAL  HYDROTHERAPY. 

of  surf  bathing,  for  it  will  be  found  that  the  appetite  and  digestion 
improve,  the  secretions  become  better  in  quality  and  quantity,  the  skin 
healthier,  the  nerves  stronger,  the  mind  clearer  and  the  body  more 
active.  I  am  satisfied  from  no  small  observation  that  many  persons 
fritter  away  the  benefit  of  their  summer  trip  to  the  seashore  by  inju- 
dicious, improper  and  excessive  indulgence  in  surf  bathing,  and  at  the 
same  time  fail  to  follow  those  hygienic  laws  of  which  ''early  to  bed  and 
late  to  rise"'  forms  a  most  excellent  basis. 

Sea  bathing  is  contraindicated  in  those  cases  in  which  the  arterial 
elasticity  for  any  reason  has  been  changed  or  lost,  as  in  arterio- 
sclerosis and  capillary  fibroses ;  also  where  the  peripheral  vessels  have 
ceased  to  respond  to  reflex  stimuli,  or  in  any  case  or  condition  in 
which  the  stimulation  of  the  bath  would  be  likely  to  favor  or  to  pro- 
duce internal  hemorrhage;  in  organic  heart  disease,  recent  rheuma- 
tism, cholelithiasis,  acute  gastro-intestinal  or  febrile  diseases,  or  any 
disease  whatsoever  in  which  the  normal  resistance  has  been  so  reduced 
as  to  make  it  necessary  to  protect  and  guard  the  patient's  forces. 

Miscarriage  may  be  caused  by  bathing  when  the  sea  is  particularly 
rough.  Sea  bathing  is  also  prejudicial  to  health  during  the  menstrual 
period.  It  is  worthy  of  note  that  otitis  media  frequently  follows 
bathing  in  a  rough  sea,  as  well  as  frequent  and  prolonged  exposure 
in  the  water. 

Swimming  Bath. 

In  this  connection  it  is  pertinent  to  consider  the  swimming  bath, 
which,  to  a  great  extent,  possesses  a  similar  value  to  that  of  the  ocean 
bath.  There  is  no  question  but  what  swimming  in  rivers,  ponds, 
lakes,  streams,  artificial  reservoirs,  and  the  like,  is  of  great  value, 
both  as  a  hygienic  and  therapeutic  procedure.  The  same  rules  and  laws 
that  govern  surf  bathing  are  applicable  to  swimming  in  still  water, 
with  this  difference,  that  as  the  water  is  not  moving,  and  therefore 
is  free  from  one  of  the  stimulating  effects  incident  to  surf  bathing, 
the  duration  of  the  swimming  bath  in  ordinary  water  should  be 
shorter,  and  as  a  rule  not  exceed  fifteen  minutes. 

It  is  well  here,  as  in  surf  bathing,  to  intermit  the  immersion  by 
exercise  between  the  plunges.  In  surf  bathing  and  swimming  the 
bather  should  npt  remain  in  the  water  until  he  becomes  chilled,  or 
until  the  lips  are  blue,  for  where  the  bath  is  carried  to  this  extent  it 
is  usually  succeeded  by  a  feeling  of  lassitude,  chilliness,  headache  and 
general  discomfort.  The  presence  of  these  symptoms  indicate  that 
the  bather  has  remained  too  long  in  the  water. 

Should  cyanosis  appear  in  the  lips,  the  bather  must  immediately 
remove  the  bath  costume,  if  possible  step  into  a  foot-tub  of  hot  water, 
at  the  same  time  applying  vigorous  rubbing  to  the  body  with  warm 
dry  towels.     When  reaction  is  established  it  should  be   followed  by 


Tl 


n 

o 


- 


THE  TECHNIQUE  OF  HYDROTHERAPY.  179 

gentle    exercise,   preferably   walking   in   the   sunlight,    for   fifteen   or 
twenty  minutes. 

Swimming  pools,  open  to  the  public,  possess  some  dangers.  The 
rules  do  not  compel  a  thorough  cleansing  bath  with  soap,  and  even  if 
this  were  so,  the  water  soon  becomes  contaminated  by  surface  excre- 
tions due  to  the  exercise  and  from  the  buccal  secretions  that  are  care- 
lessly expectorated  into  the  water.  These  unhygienic  conditions,  in- 
separable from  a  public  pool,  are  the  means  of  spreading  skin,  eye 
and  ear  diseases.  Especially  common  is  a  furunculosis  of  the  external 
auditory  meatus  and  conjunctivitis.  This  does  not  occur  where  lakes, 
rivers  and  streams  are  used. 

Mineral  Baths. 

.Medicine  from  time  immemorial  has  had  her  follies,  and  hydro- 
therapy has  likewise  not  been  free  from  such  delusions.  Among  the 
prominent  hydriatic  lapses  may  be  mentioned  the  following  baths: 
Mineral  acids,  chloride  of  calcium,  iron,  sulphur,  tan,  bran,  malt, 
glue,  milk,  whey,  blood,  wine,  horse-dung,  guano,  oak  bark,  starch, 
soup,  corrosive  sublimate,  etc.,  any  one  of  which  has  stamped  on  its 
face  lack  of  common  sense  and  charlatanry  of  the  purest  ray  serene. 
I  think  it  may  be  stated  with  practically  no  fear  of  contradiction,  save 
by  those  who  operate  mineral  springs,  that  there  is  no  evidence  what- 
soever at  hand  to  substantiate  the  statements  that  certain  mineral 
substances  dissolved  in  water,  in  such  infinitesimal  amounts  as  are 
found  in  the  natural  waters,  can  have  any  special  value  to  the  cu- 
taneous surface.  It  seems  to  me  that  these  baths  possess  value  only 
as  they  produce  the  same  thermic  and  other  impressions  upon  the 
periphery  that  are  to  be  derived  from  the  use  of  plain,  unmedicated 
or  simple  waters.  The  laity  are  very  apt  to  be  led  astray  in  their 
estimate  of  mineral  waters  and  their  virtues  as  an  internal  beverage 
and  as  an  external  hydriatic  weapon  against  diseases,  seeming  to 
forget  entirely  the  major  factors  of  absence  from  business,  freedom 
from  care  and  worry,  open  air"  and  pleasant  surroundings,  all  of  which 
tend  to  produce  a  rejuvenation  of  the  system,  aside  from  the  mineral 
water. 

The  author  has  visited  many  mineral  springs  of  this  kind,  and 
prides  himself  upon  the  fact  that  while  he  has  tasted,  he  has  never 
used  any  of  the  waters,  and  has  secured  as  much  good  and  benefit 
from  his  sojourn  as  the  most  eloquent  and  flannel-mouthed  exponent 
of  their  accepted  virtues.  Of  course,  this  does  not  mean  that  there 
are  not  some  springs  that  possess  value,  but  my  observation  and  ex- 
perience lead  me  to  believe  that  those  waters  naturally  heated  have 
given  the  best  results  per  sc,  which  I  believe  to  be  due  to  the  fact  that 
patients  gain  spoliative  benefits  that  may  be  derived  from  the  appli- 
cation of  any  water  at  a  high  temperature.     It  will  be  seen  that  even 


180  PRACTICAL  HYDROTHERAPY. 

in  these  instances  a  remnant  of  a  doubt  remains.  Probably  of  all 
mineral  baths  that  are  most  popularly  sought  the  sulphur  bath  is  the 
most  common,  and  I  believe  that  no  thoughtful  man  will  for  a  mo- 
ment entertain  the  belief  that  there  is  the  slightest  benefit  to  be  ob- 
tained from  the  addition  of  sulphur  to  the  water  used.  European  hy- 
driatists  who  practice  at  the  great  spas,  and  who  utilize  their  waters, 
take  a  much  broader  view  of  this  matter  than  their  American  con- 
temporaries, a  notable  instance  of  which  being  the  Schott  brothers, 
at  Nauheim,  in  Germany.  The  time  is  fast  approaching  when  the 
medical  profession  should  post  itself  thoroughly  regarding  this  rap- 
idly expanding  farce.  It  does  not  mean  that  hydrotherapy  shall  not 
be  utilized  at  springs,  but  that  it  should  be  utilized  in  an  intelligent, 
far-seeing,  scientific  manner,  freed  from  charlatanry  and  quackery, 
and  administered  to  patients  based  upon  a  thorough  knowledge  of 
the  physiological  action  of  thermic  values.  In  this  connection  it  is 
interesting  to  note  again  what  has  been  most  frequently  referred  to  in 
previous  sections  of  this  work,  that  the  water  contained  in  the  bath 
is  not  absorbed  by  the  skin — ergo,  what  is  the  value  of  the  mineral 
constituents  to  the  bather?  It  must  be  borne  in  mind  that  in  the  Nau- 
heim bath,  one  of  the  few  mineral  baths  recommended,  it  is  not  the 
contained  mineral  so  much  as  the  presence  of  an  active,  effervescent 
carbon  dioxide  gas,  which  is  not  absorbed,  that  does  the  work,  acting 
through  the  peripheral  nerve  terminations  in  the  skin  surface. 

Douches. 

In  nearly  all  of  the  preceding  methods  of  treatment  that  we  have 
considered  the  human  hand  has  taken  an  active  part  in  the  applica- 
tion, but  in  the  douche  the  physiological  effects  are  obtained  by  the 
use  of  apparatus  which  drive  or  throw  the  water  upon  the  entire  or 
various  portions  of  the  skin  surface.  The  many  forms  of  application 
of  hydrotherapy  reach  their  acme  in  the  douche,  and  this  instrument 
of  therapy  is  the  aim  and  object  of  most  operators,  for  by  its  use  the 
most  powerful  physiological  effects  may  be  produced.  The  douche 
is  the  most  satisfactory,  flexible  and  adaptable  tonic  in  hydrotherapy, 
and  is  capable  of  producing  changes  marvelous  to  those  who  are  un- 
acquainted with  its  use  and  effects.  It  should  be  noted  that  in  douches 
we  have  to  deal  not  alone  with  thermic  impressions  upon  the  sur- 
face, but  with  mechanical  effects  as  well,  which  are  of  a  perturbating 
or  concussive  character,  and  while  this  latter  plays  an  important  part 
in  the  effects  of  the  douche,  yet  the  temperature  effect  is  in  reality 
the  most  important.  It  is  to  be  noted  in  all  methods  by  which  water 
is  driven  against  the  human  body  that  its  action  is  strictly  limited  to 
the  moment  of  its  application,  as  the  water  at  once  flows  or  falls  from 
the  surface.  A  douche,  therefore,  is  the  application  of  water  to 
the  body   surface  in  single  or  multiple  columns   or  streams   at   dif- 


Plate  101 — Author's  Douche  Apparatus. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  181 

ferent  temperatures  and  under  varying  degrees  of  mechanical  stimu- 
lation, the  latter  derived  from  atmospheric  pressure.  There  are  dif- 
ferent kinds  of  douches.  They  may  be  administered  from  a  nozzle 
with  an  opening  so  fine  as  to  make  the  application  painful,  or  broad 
like  a  fan,  or  as  multiple  little  streams.  Each  and  every  douche  may 
be  hot,  cold,  or  may  be  alternate  hot  and  cold ;  in  the  last  named  the 
sudden  thermic  changes  enhancing  the  physiological  action  of  each 
temperature.  In  like  manner  the  mechanical  stimulation  may  be  of  any 
grade  of  strength  from  the  mildest  to  the  most  powerful.  It  should, 
however,  be  borne  in  mind  that  the  physiological  action  of  an  affu- 
sion, the  mildest  douche,  and  the  jet,  the  most  powerful,  is  one  and 
the  same,  the  difference  in  effect  lying  more  particularly  in  the  vari- 
ations of  the  method  and  in  the  pressure  used.  Douches  are,  as  a  rule, 
more  agreeable  to  the  majority  of  individuals  than  the  other  forms 
of  hydriatic  procedure,  because  by  its  stimulating  mechanical  action  it, 
in  a  brief  period,  not  alone  produces  its  effect,  but  hastens  and  in- 
creases reaction.  For  this  reason  in  institutions,  sanatoria  and  hospi- 
tals, especially  where  the  chronic  invalid  is  treated,  the  douche  is  much 
employed,  not  alone  for  its  well-known  therapeutic  power,  but  be- 
cause of  its  brevity  of  application,  which  makes  it  popular  with  the 
patient  and  saves  much  valuable  time  where  many  are  to  be  served. 
I  am  of  the  opinion  that  in  the  douche  we  have  the  most  powerful  and 
far-reaching  of  the  therapeutic  weapons,  and  one  that  should  be  more 
frequently  used.  Those  who  have  never  used  (personally)  a  powerful 
douche  have  missed  a  pleasant  experience,  and  were  physicians  to  try 
this  measure  more  frequently  upon  their  own  persons  I  am  confident 
they  would  have  less  recourse  to  medicines  in  chronic  diseases  and 
make  more  use  of  hydrotherapy.  It  sets  the  tissues  in  a  vibration 
impossible  to  describe;  experienced,  it  is  never  forgotten.  The  writer, 
after  eighteen  years'  practical  experience  in  a  large  practice,  and  in  the 
daily  use  of  hydrotherapy,  is  at  a  loss  to  differentiate  physiological  dis- 
tinctions, niceties,  and  need  for  separate  consideration  of  "liver,  spleen, 
epigastric,  perineal,  ascending  and  descending,  etc.,  douches,"  so  much 
insisted  upon  by  French  and  German  writers  and  by  some  hydriatists 
in  this  country.  Owing  to  anatomical  differences  in  structure  and 
its  varying  vascular  distribution,  certain  reflexes  may  arise  that  are 
different  in  one  place  from  those  in  another,  but  the  difference  is  so 
small  that  it  can  be  overlooked  in  view  of  the  simplicity  and  clearness 
that  is  gained  by  reducing  the  subject  of  douches  to  its  simplest  terms. 
Following  the  plan  heretofore  insisted  upon,  the  writer  will  give  a 
brief  description  of  each  "douche  method,"  its  peculiarities  and  ad- 
vantages, and  will  then  give  the  physiological  action,  therapeutics,  etc., 
of  douches  in  general.  I  will  consider  douches  under  four  headings, 
proceeding  from  the  simpler  to  the  complex  and  more  powerful. 
Douches  are  divided  as  follows : 


182  PRACTICAL  HYDROTHERAPY. 

1.  Affusions. 

2.  Shower  or  vertical  rain  bath. 

3.  Circular  rain,  horizontal  rain,  needle  or  spray  bath. 

4.  Jet  douche  (jet  or  fan). 

Douches  are  administered  by  means  of  certain  attachments  that 
are  in  connection  or  conjunction  with  what  is  known  as  the  "douche 
apparatus."  In  constructing  the  douche  apparatus  we  should  have 
delivered  to  it,  in  pipes  not  less  than  one  and  one-half  inches — the 
author  uses  two — hot,  cold  and  ice  water,  under  a  sufficient  pressure 
to  secure  satisfactory  results.  It  should  be  in  direct  connection  with 
both  hot  and  cold  water  supply,  and  so  arranged  that  the  use  of  hot 
and  cold  water  elsewhere  will  not  interfere  with  its  operation.  Eighteen 
years  ago  the  writer  constructed  a  simple  and  efficient  douche  appa- 
ratus which  serves  him  excellently  to  this  day,  and  which  can  be  seen 
in  the  accompanying  cut.  This  apparatus  is  attached  to  the  wall,  and 
consists  of  two  separate  and  distinct  divisions,  both  of  which  are  sup- 
plied with  the  three  kinds  of  water,  the  left  hand  division  being  con- 
nected with  the  circular  needle  bath,  triangle  and  perineal  douche,  the 
right  hand  one  with  the  jet  and  fan  douches.  This  apparatus  is  con- 
structed of  one  and  one  and  a  half  inch  brass  nickel-plated  pipes,  and 
the  three  kinds  of  water  are  delivered  to  the  mixing  chamber,  from 
which  a  single  pipe  conducts  the  water  to  the  respective  pieces  of  ap- 
paratus. The  apparatus  is  so  arranged  that,  in  giving  the  alternate  or 
Scottish  douche,  hot  water  may  be  obtained  from  one  side  and  cold 
from  the  other,  the  apparatus  thus  meeting  every  requirement  of  a 
correct  treatment  apparatus.  The  mixing  chambers  are  supplied  with 
accurate  thermometers,  and  a  gauge  shows  the  amount  of  pressure 
employed.  With  this  very  simple  instrument  of  precision  water  may 
be  applied  in  any  form  of  douche  with  rapidity,  facility  and  accuracy. 
The  writer  has  used,  and  has  in  his  sanatorium,  one  of  Dr.  Simon 
Baruch's  douche-tables,  a  picture  of  which  is  shown,  and  of  which  its 
originator  has  the  following  to  say : 

"The  douche-table  is  a  box  four  feet  long,  three  feet  high  and  two 
feet  wide,  covered  with  marble.  Enclosed  within  the  box  is  a  com- 
bination of  pipes  connected  with  the  hot  and  cold  water  and  steam 
supply  on  the  one  hand  and  a  hose  with  other  terminal  arrangement 
on  the  other.  The  hot  and  cold  water  supply  is  by  the  usual  con- 
trivance controlled  by  stop-cocks,  the  terminal  rods  and  levers  of 
which  issue  through  the  opening  in  the  upper  portion  or  slab  of  the 
douche-table,  as  may  be  seen  in  the  diagram.  The  outflow  pipe,  con- 
trolled by  the  stopcock,  regulates  the  pressure  of  the  water,  which  is 
plainly  indicated  upon  the  gauge.  This  enables  the  attendant  to  ar- 
range any  pressure  required,  either  before  the  douche  is  adminis- 
tered or  while  it  is  flowing  upon  the  body.  A  thermometer  is  so  ar- 
ranged that  its  bulb,  incased  in  an  openwork  metal  tube,  lies  within 
the  mixer  and  shows  the  temperature  of  the  water  flowing  upon  the 


Plate  102— Douche  Table. 


H+ 


>$+ 


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Plate   103— Douche  Table    (Baruch). 


r 

x 


THE  TECHNIQUE  OF  HYDROTHERAPY.  183 

patient.      A    second  clock   furnishes   information   regarding  the   dura- 
tion." 

It  is  from  these  apparati  that  the  various  forms  of  douches  are 
administered  and  which  we  will  now  consider,  the  only  exception  being 
the  affusion. 

Affusicn. — The  '"affusion"  is  a  procedure  by  which  a  stream  of 
water  issuing  from  a  bucket  or  pitcher  is  thrown  or  falls  upon  the 
patient  sitting  or  standing  in  an  empty  tub.  The  writer  uses  the  affu- 
sion witli  comparative  rarity,  and,  as  a  rule,  only  in  connection  with  the 
half  bath  or  for  some  local  effect.  It  has  been  his  experience  that 
it  is  best  to  employ  a  bucket  provided  with  a  partial  covering 
and  large  opening  through  which  a  broad  stream  of  water  may  be 
concentrated  more  or  less  upon  the  patient.  It  will  be  seen  at  once 
that  the  affusion  can  be  made  stronger  or  weaker  according  to  the 
temperature  of  the  water  and  the  height  from  which  it  falls.  It  is 
my  custom  to  generally  administer  the  affusion  from  55°  to  70°  F., 
and  I  have  found  that  it  is  advantageous  for  the  patient  to  be  sitting 
and  to  administer  it  to  both  the  chest  and  back.  This,  in  connection  with 
the  half  bath  with  friction,  has  been  a  favorite  method  of  the  writer's 
in  treating  locomotor  ataxia,  and  to  which  the  reader  is  referred  in 
the  section  upon  therapeutics.  It  has  been  suggested  by  Baruch  that 
in  conditions  of  coma,  delirium  and  adynamia  the  patient  should  sit 
or  recline  in  water  at  a  temperature  of  100°  F.,  and  receive  the  affu- 
sion at  temperatures  varying  from  45°  to  60°.     He  says: 

"It  is  this  method  by  which  Currie  made  his  remarkable  cures  in 
typhus  fever,  using  chiefly  sea-water  on  board  the  ship.  In  scarlatina, 
when  the  system  is  overwhelmed  with  poison,  the  circulation  embar- 
rassed, the  skin  pale  or  marble  or  cyanotic,  the  respiration  shallow, 
temperature  high,  pulse  rapid  and  feeble,  truly  marvelous  results  may 
be  obtained  by  the  judicious  brief  use  of  affusions.  Reaction  occurs 
rapidly,  and  with  it  come  an  improved  peripheral  and  general  circula- 
tion, deepened  inspiration,  bright  countenance  and  roseate  skin.  Let 
not  the  fear  of  cold  water  deter  anyone  from  resorting  to  cold  affu- 
sions, 70°  to  60°  F.,  in  these  desperate  cases." 

It  is  always  a  good  plan  before  administering  the  affusion  to  have 
the  patient's  face  and  neck  thoroughly  cooled.  There  is  just  a  little 
knack  in  giving  the  affusion,  and  that  is  to  swing  the  bucket  to  a  suffi- 
cient height  so  as  to  cause  the  water  to  dash  against  the  patient;  in 
feeble  patients,  where  the  affusion  is  applied  to  the  chest,  it  is  well  to 
have  the  patient  break  the  first  part  of  the  stream  by  placing  his  hands 
against  the  chest  wall  and  then  quickly  removing  them. 

Shower  Bath. — The  shower  bath,  vertical  rain,  or  rain  douche, 
as  it  is  variously  styled,  consists  of  a  perforated  disk  from  which  a 
large  number  of  fine  streams  of  water  fall  upon  the  patient.  This  ap- 
plication resembles  somewhat  the  effect  of  the  circular  rain  or  needle 


184  PRACTICAL  HYDROTHERAPY. 

douche,  owing  to  the  large  quantity  of  water  that  flows  over  the  body 
surface.  The  temperature  effects  are  practically  the  same  as  in  all 
douches,  but  the  mechanical  or  pressure  effects  are  less  than  in  the 
next  two  forms  to  be  considered,  although  it  is  greater  than  in  the 
affusion.  The  rows  should  be  so  arranged  that  the  water  can  be  made 
to  fall  upon  the  head  at  an  angle  when  this  is  so  desired,  as  some  pa- 
tients are  exceedingly  sensitive  to  water  falling  straight  down  upon 
their  head.  This  is  a  procedure  of  considerable  value,  and  is  quite  a 
stimulant  to  the  nervous  system,  and  possessing  many  of  the  valuable 
effects  of  the  douche.  This  is  the  favorite  percutient  measure  in  pri- 
vate homes,  and  the  shower  or  vertical  rain  is  now  a  part  of  nearly 
every  well-kept  private  bath-room.  In  sanatoria,  as  a  rule,  the  rows 
permit  of  larger  volumes  of  water  under  greater  pressure  than  is  found 
in  private  houses.  The  shower  is  a  part  of  the  standard  apparatus 
manufactured  by  companies  who  deal  in  plumbing  supplies,  and  is 
easily  obtainable  at  reasonable  prices. 

Circular,  Horizontal,  Rain,  Needle  or  Spray  Bath. — In  my  sana- 
torium I  employ  two  kinds  of  circular,  needle  or  rain  baths,  one  of 
which  is  the  old-style  needle  bath  supplied  with  semicircular  perforated 
pipe  and  attached  to  one  of  the  mixing  chambers  of  the  douche  appa- 
ratus. To  the  left  of  it  stands  a  circular  needle  bath,  popularly  termed 
in  the  institution  the  "triangle,"  which  was  originated  by  Baruch,  and 
which  the  author  has  had  in  use  for  a  number  of  years.  This  con- 
sists of  three  standard  upright  brass  nickel-plated  pipes  to  which  are 
attached  four  or  five  rosettes,  three  inches  in  diameter,  containing  ap- 
proximately fifty  fine  openings,  the  three  upper  rosettes  so  arranged 
that  the  stream  of  water  may  be  directed  downward,  so  that  a  person 
of  short  height  will  not  receive  the  volume  of  water  upon  the  face  and 
head.  In  the  older  circular  rain  bath  the  writer  has  obviated  this 
difficulty  by  the  use  of  three  stools  of  different  sizes  made  of  cedar 
wood.  The  circular  rain  or  needle  bath  is  a  very  active  and  powerful 
procedure,  and  by  its  use  one  is  enabled  to  obtain  far-reaching  effects. 
The  multitude  of  fine  streams  under  considerable  pressure  falling  upon 
a  large  area  of  cutaneous  surface,  stimulate  by  their  thermic  and  me- 
chanic effects  all  the  structures  immediately  in  contact  with  the  water, 
and  arouse  extensive  reflex  action.  It  is  a  milder  procedure  than  the 
jet  douche  and  a  stronger  one  than  the  shower  bath.  This  bath  has  in 
the  writer's  hands  yielded  him  some  of  the  most  satisfactory  results  ob- 
tainable in  the  whole  field  of  hydrotherapy,  and  it  would  be  difficult 
to  substitute  as  effective  a  weapon  should  this  be  lost  to  the  profession. 
It  is  especially  valuable  for  women,  many  of  whom  do  not  stand  well 
the  stronger  jet  douche. 

Jet  Douche. — The  jet  douche  or  "hose,"  as  it  is  called  in  the  par- 
lance of  the  bath-room,  consists  of  a  hose  attached  to  cne  of  the  outlet 
pipes  of  the  douche  apparatus,  and  to  the  other  end  of  which  is  a  metal 


Plate  105— Shower  Baths. 


Plate   106 — Affusion  to  Chest. 


Plate  107— Circular,  Horizontal  Rain  or  Needle  Bath. 


THE  TECHNIQUE  OF  HYDR0THERA1  185 

connectii  n  to  which  can  be  screwed  various  attachments  for  modifying 
the  size  and  shape  of  the  stream  delivered  to  the  patient.  The  jet 
douche  is  usually  administered  through  a  nozzle,  the  diameter  of  the 
opening  ranging  from  one-fourth  to  one-half  inch.  As  before  stated, 
the  douche  apparatus  should  he  so  arranged  as  to  possess  two  of  these 
jets  in  order  that  the  Scottish  douche  may  be  administered.  The  jet 
douche  is,  in  the  opinion  of  the  writer,  from  careful  clinical  observa- 
tion and  from  long  personal  experience,  the  most  powerful  of  all  forms 
of  hydriatic  treatment.  Administered  at  high  or  low  temperatures, 
under  a  strong  pressure,  it  is  capable  of  aronsing  the  most  sluggish 
and  intolerant  function  of  the  human  body.  It  is  a  powerful  invig- 
orant.  revulsive  and  sorbefacient  when  administered  as  a  Scottish 
douche  for  local  conditions,  especially  of  a  chronic  inflammatory  na- 
ture, particularly  when  located  in  the  extremities. 

The  fan  douche  is  nothing  more  or  less  than  a  very  simple  modi- 
fication of  the  jet  douche,  and  while  there  is  a  special  nozzle  or  attach- 
ment for  producing  the  fan  douche,  the  author  would  not  advise  its 
use,  as  it  is  really  objectionable  rather  than  beneficial.  The  simplest 
way  of  producing  the  fan  douche  is  to  place  the  finger  over  the  nozzle 
of  the  jet  so  that  the  water  will  fall  upon  the  patient  in  a  broadened 
and  thin  stream.  In  this  way  certain  structures  that  would  be  unable 
to  stand  the  action  of  the  jet  douche  gain  all  the  value  of  this  appli- 
cation without  having  sensitive  parts  subjected  to  the  pain  and  dis- 
comfort that  the  full  jet  might  produce.  In  case  the  temperatures 
used  are  too  high,  and  the  force  of  the  stream  too  strong  for  the  human 
finger  to  stand,  by  the  use  of  a  small  piece  of  wood,  preferably  of 
cedar,  the  stream  may  be  broken  without  having  the  attendant  suffer 
any  discomfort  from  the  temperature  administered.  It  is  the  writer's 
favorite  method  to  combine  the  fan  and  jet  douches,  using  the  fan 
douche  upon  the  chest  and  the  tender  walls  of  the  abdomen,  and  the  jet 
douche  upon  the  spine,  back,  lower  limbs  and  feet.  It  is  for  this  reason 
that  I  do  not  advise  the  use  of  a  special  nozzle,  as  it  would  compel  the 
removal  and  reattachment  of  these  nozzles  several  times,  during  the 
interim  of  which  the  patient  would  become  chilled,  thus  robbing  him 
of  all  the  benefits  that  the  douche  commands. 

The  perineal  douche  is  a  modification  of  the  jet,  and  is  applied 
through  a  nozzle  directed  from  the  floor,  the  patient  being  seated  upon 
a  stool  through  which  a  hole  has  been  bored  to  permit  the  stream  to 
reach  the  perineum.  This  douche  is  of  some  value  in  the  treatment 
of  sexual  weakness,  prostatic  troubles  and  hemorrhoids.  It  should  be 
gently  applied  at  the  start  and  gradually  increased  in  force. 

The  Scottish  or  alternate  douche  is  simply  the  alternate  application 
of  a  hot  jet  douche  followed  by  a  cold  jet  douche.  While  it  is  generally 
employed  as  a  jet  douche,  still  it  may  be  applied  in  almost  any  form 
of  douche.     In  the  application  of  the  Scottish  douche  it  should  be 


186  PRACTICAL  HYDROTHERAPY. 

borne  in  mind  that  there  is,  as  a  rule,  a  ratio  between  the  application 
of  heat  and  the  application  of  cold.  Roughly  speaking,  it  is  usually 
four  or  six  to  one — that  is  to  say,  the  hot  application  should,  as  a  rule, 
be  long  and  the  cold  application  short.  Reducing  it  to  time,  the  hot  ap- 
plication should  range  somewhere  between  one-half  and  three  minutes, 
and  the  cold  application  from  five  to  thirty  seconds.  The  aim  and  ob- 
ject of  the  Scottish  douche  is  to  intensify  the  revulsive  effect  obtained 
from  both  the  application  of  the  hot  and  cold  water.  Where  we  have 
to  deal  with  conditions  that  are  local  and  which  especially  affect  tissues 
such  as  joints,  sciatic  nerve,  etc.,  an  excellent  method  of  treatment  is 
to  precede  the  use  of  the  Scottish  douche  by  a  general  sweating  method. 
Its  application  combines  all  the  physiological  influences  of  both  the  hot 
and  cold  douches,  and,  in  fact,  rather  intensifies  their  action.  It  is  one 
of  the  most  powerful  absorbents  of  inflammatory  material  that  can  be 
placed  in  the  hands  of  the  therapeutist.  It  produces,  in  addition,  a 
marked  mechanical  influence.  The  temperatures  usually  administered 
range  from  100°  to  125°  F.,  while  the  temperatures  of  the  cold  water 
range  between  55°  and  70°  F. 

It  may  be  stated  that  a  sine  qua  non  to  its  successful  use  is  ability 
to  manage  and  direct  the  forcible  impact  of  water  upon  the  whole  body 
or  any  part  of  it;  the  operator  should  be  able  to  control  the  form, 
temperature,  pressure  and  duration  of  the  douche.  It  should  be  no- 
ticed that  variations  in  temperature  and  pressure  are.  easily  distin- 
guished by  patients. 

Practical  common  sense  will  at  once  see  that  while  there  is  a  dif- 
ference in  the  effect  of  water  acting  in  a  concentrated  form,  as  in  a 
jet  douche  or  in  the  separated  multiple  little  streams  of  a  circular 
needle  douche,  yet  this  is  only  a  difference  in  degree  and  extent  rather 
than  an  ultimate  physiologic  difference.  Douches  are  usually  admin- 
istered at  temperatures  ranging  from  45°  to  120°  F.,  and  where  they 
are  very  hot  or  very  cold  they  should  be  of  brief  duration  and  act  as 
a  stimulant,  increasing  tone  and  well-being.  Hot  douches  (104°  to 
110°  F.)  should  not  exceed,  in  general  applications,  a  half  to  two  min- 
utes, preferably  as  an  average  one  minute,  the  hotter  the  douche  the 
briefer  the  time.  Cold  douches  (45°  to  70°  F.)  should  not  exceed,  in 
general  applications,  ten  to  thirty  seconds,  preferably  as  an  average 
fifteen  seconds,  and  likewise  should  be  proportionately  briefer  the 
lower  the  temperature.  It  is  an  excellent  rule  to  commence  treatment 
with  a  temperature  of  100°  F.  for  one  minute,  followed  by  a  reduc- 
tion to,  say,  80°  F.  for  ten  seconds,  increasing  the  hot  water  one  de- 
gree daily  until  104°  F.  is  reached,  and  reducing  the  cold  water  two 
or  three  degrees  daily  until  60°  or  50°  F.  is  reached,  and  in  like  man- 
ner increasing  pressure  steadily. 

Cold  temperatures  are  secured  in  summer  by  ice  water  obtained 
by  passing  water  through  a  coil  of  pipes  surrounded  by  ice.     This  is 


Plate  108 — Perineal  Douche  Apparatus. 


Plate    1(9 — Perineal    Douche. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  187 

only  neces>ary  in  summer.  In  some  places  water  of  sufficiently  low 
temperature  is  obtained  by  sinking  deep  wells,  thus  obviating  the  trouble 
and  expense  of  the  ice-box. 

The  jet  is  usually  administered  with  the  patient  standing,  but  if 

he  be  quite  feeble  he  may  sit.  In  many  cases  it  is  well  to  combine  the 
different  forms  of  the  douche  in  an  application,  beginning  perhaps 
with  the  warm  circular  needle  douche,  finishing  with  the  cold  fan  • 
douche  over  the  body  and  the  cold  jet  to  the  spine,  legs  and  feet. 
Where  the  entire  body  is  treated  we  would  expect  general  physiolog- 
ical effects,  and  where  the  applications  are  local  purely  local  and  re- 
flex effects.  The  most  pronounced  local  effects  are  found  in  the  Scot- 
ti.-h  douche.  The  douche  should  never  be  administered  except  upon 
the  order  or  under  the  medical  direction  of  a  well-trained  hydriati.-t. 
as  it  is  too  vigorous  an  application  for  the  uninitiated  or  to  be  left  to 
careless  routine  treatment.  The  jet  douche  is  usually  applied  to  the 
back  first,  then  the  legs  and  arms,  and  then  slowly  broken  for  the 
chest  and  abdomen,  and  lastly  to  the  feet.  Where  general  effects  are 
desired,  and  some  local  effect  in  an  organ  is  sought,  the  cold  jet  should 
be  applied  as  a  finishing  application  over  the  part  it  is  desired  to  most 
influence.  The  action  of  the  douche,  as  in  many  other  measures,  is 
enhanced  by  some  procedure  that  has  for  its  object  the  increasing  of 
the  cutaneous  circulation,  the  collection  of  heat  upon  the  surface  and 
the  increasing  of  skin  sensitiveness.  To  this  end  the  wet  and  dry  pack, 
superheated  dry  hot  air.  the  hot-air  box,  steam  box.  the  incandescent 
electric  light,  the  arc  light,  etc..  are  used.  After  no  inconsiderable 
experience,  I  feel  that  the  general  requirements  are  more  nearly  met 
by  the  incandescent  electric  light  bath  than  any  other  known  method, 
and  I  give  this  preference  except  in  special  cases.  The  aim  and  object 
of  the  douche  is  to  bring  the  patient,  as  soon  as  possible,  under  the 
influence  of  low  temperatures  and  high  pressure.  The  favorite  method 
of  use,  however,  is  first  to  give  a  hot  or  warm  douche,  following  same 
by  a  cold  one  of  brief  duration.  The  douche  should  always  be  kept 
moving,  and  by  so  doing  many  disagreeable  sensations  of  heat  or  cold 
will  be  obviated. 

Reaction  is  more  immediate  and  complete,  for  the  colder  water 
and  briefer  application,  coupled  with  the  mechanical  stimulus  of  the 
impact,  overcomes  the  depressing  effect  of  the  low  temperatures;  in 
fact,  the  skin  frequently  reddens  under  the  cold  water  during  its  appli- 
cation in  those  whose  reaction  is  well  developed.  Owing  to  the  limited 
areas  over  which  various  douches  play,  and  the  accompanying  massage, 
they  do  not  produce  the  painful  impressions  as  if  the  patient  was 
totally  immersed  in  cold  water.  The  author  believes  that  the  best  re- 
sults are  obtained  from  brief  douches  under  considerable  pressure  and 
thermic  change  adapted  to  the  individual  case.  The  douche  encourages 
both  thermic  and  circulatory  reaction — the  former  brought  about  by 


188  PRACTICAL  HYDROTHERAPY. 

rapid  cooling  of  the  skin  surface,  the  latter  because  of  the  intermit- 
tent mechanical  vibrations  of  the  stream  upon  the  surface.  It  will 
thus  be  seen  that  all  douches  depend  for  their  effects  upon. six  fac- 
tors, viz. : 

1.  Form — affusion,  circular  needle,  jet. 

2.  Temperature — hot.  cold,  alternate  hot  and  cold. 

3.  Duration — short  or  long. 

4.  Pressure — amount  of  mechanical  stimulation. 

5.  Distance — from  attendant. 

6.  Local  and  general  applications. 

Physiological  Action  of  the  Hot  Douche. — This  has  been  incident- 
ally considered  in  the  foregoing  remarks,  but  we  will  now  take  up  and 
consider  in  detail  the  physiological  action  of  the  hot  douche.  The 
temperatures  range  from  100°  to  125°  F.,  though  the  latter  or  higher 
temperatures  are  only  borne  after  hydriatic  education.  Local  applica- 
tions may  be  made  at  much  higher  temperatures  than  general  ones, 
higher  with  moving  than  with  still  water. 

The  influence  upon  temperature  is  to  first  produce  a  reddening  of 
the  skin  owing  to  the  close  relation  between  temperature  and  vascular- 
ity. The  temperature  of  the  body  is  raised  if  the  application  is  general 
or  a  local  rise  if  localized,  this  increase  being  due  to  the  prevention  of 
heat  elimination  and  by  increasing  its  production. 

Its  influence  upon  circulation  is  active.  The  first  and  transient 
influence  is  to  contract  the  peripheral  blood-vessels,  followed  almost 
immediately  by  dilatation,  atonic  in  character  and  causing  a  passive 
congestion  of  the  skin,  which  becomes  of  a  cherry-red  color.  The 
heart  is  first  slowed,  with  temporary  increased  force  of  puis*  beat, 
but  soon  it  becomes  accelerated,  due  to  dilatation  of  the  arterial  system 
in  the  skin,  coincident  with  perspiration  and  a  lowering  of  arterial 
tension.  As  a  reflex  effect  the  internal  blood-vessels  are  contracted. 
The  cerebral  blood-vessels  may  dilate  at  the  start  and  give  a  sensation 
of  oppression  in  the  head,  of  tightness  and  throbbing.  Later  the 
dilated  peripheral  blood-vessels  cause  a  reflex  contraction  of  the  cere- 
bral ones,  causing  an  internal  anemia,  especially  of  the  brain,  demand- 
ing in  both  instances  cold  applications  to  the  head. 

L'pon  respiration  the  influence  is  to  increase  their  number,  diminish 
their  depth  and  to  produce  a  slight  feeling  of  weight  and  oppression 
upon  the  chest.  Moist  heat  produces  these  effects  at  a  much  lower 
temperature  than  dry  heat,  and  in  the  latter  inhalation  of  the  hot  air 
increases  the  effects.  There  is  a  greater  heat  loss  by  exhalation  and 
respiratory  activity. 

Upon  metabolism,  the  most  intricate  process  of  vital  action,  the 
effect  is  to  increase  the  action,  directly  stimulating  perspiration,  the 
glandular  action  of  the  skin,  and  increasing  the  elimination  of  waste 


Plate  110 — To  Show  Compact  Arrangement  of  Horizontal  Rain  or  Needle 
Bath,   Triangle,    Perineal    Douche,   and    Shower   Bath. 


Plate  112— Fan  Douche  to  Spine. 


THE  TECHNIQUE  OP  HYDROTHERAPY.  189 

material  by  increasing  the  secretion,  elimination  and  oxidative  pro- 
cesses of  the  bod\-. 

Upon  the  nervous  system  heat  is  a  powerful  excitant,  and  where 
long  continued  may  lead  to  exhaustion.  Applied  to  the  nerve  termin- 
ations  in  the  skin,  its  influence  is  conveyed  to  the  spinal  cord  and 
thence  to  the  heat  centers  in  the  medulla,  stimulating  vital  processes. 
These  sensory  impressions  are  of  a  powerful  character,  and  give  rise 
to  myriad  reflex  effects.  After  a  short  time  stimulating  effects  give 
way  to  relaxing,  sedative  and  depressing  influences,  well  known  to 
those  who  use  the  hot  bath.  Headache,  sense  of  fullness  or  band-like 
feelings  about  and  around  the  head,  giddiness,  lightness  and  cerebral 
oppression  are  some  of  its  later  effects.  Upon  the  peripheral  nerves 
it  is,  under  low  pressure,  analgesic,  under  high  pressure  stimulant. 
Muscular  nerves  are  markedly  influenced,  spasm  being  overcome  and 
relaxation  taking  place. 

Reaction  is  transient  and  is  followed  by  atonic  conditions. 

Therapeutics  of  the  Hot  Douche. — Its  principal  value  is  that  of  a 
preparatory  or  alternate  to  the  cold  douche,  and  is  rarely  used  alone. 
Where  we  have  to  deal  with  superficial  tenderness,  hyperesthesia,  in 
neuralgia,  etc.,  it  sometimes  proves  of  value  alone,  but  the  writer  has 
found  even  in  these  cases  the  necessity  exists  for  following  their 
application  with  carefully  graduated  cold  applications.  The  hot 
douche  reaches  its  maximum  value  in  connection  with  cold  percutient 
measures,  and  is  only  valuable  in  this  connection. 

Physiological  Action  of  the  Cold  Douche. — The  writer  is  firmly 
of  the  opinion  that  the  cold  douche  should  never  be  used  without  the 
preliminary  and  preparatory  influence  of  heating  procedures  or  the 
hot  douche.  Cold  applications  of  low  temperature  is  the  aim  of  the 
hydriatist,  together  with  maximum  mechanical  stimulation. 

The  action  of  the  cold  douche  upon  temperature  is  to  primarily 
produce  a  chilling  of  the  surface  and  contraction  of  blood-vessels. 
The  capillaries  of  the  skin  contract,  the  flow  of  blood  to  the  skin  is 
checked.  The  douche  does  not  reduce  systemic  temperature,  for  the 
system  rallies  to  overcome  its  effect,  the  development  and  production 
of  heat  being  increased.  The  temperature  of  the  surface  in  contact 
with  the  cold  water  may  be  lowered,  but  only  temporarily.  The  per- 
cussive or  mechanical  effect  of  douches  lessens  the  impression  of  cold, 
and  lower  temperatures  may  be  advantageously  administered. 

Upon  the  circulation  the  cold  douche  is  decisive  and  tonic  in  action. 
During  its  immediate  application  the  heart's  beat  is  increased,  the 
pulse  is  smaller,  but  the  subsequent  effect  is  to  lessen  the  number  of 
beats  and  to  markedly  increase  the  volume  of  the  pulse,  while  at  the 
same  time  the  flow  of  blood  through  the  heart  is  accelerated.  There 
is  a  rise  in  blood  pressure  under  its  use,  but  a  secondary  diminution 
takes  place  when  the  peripheral  blood-vessels  are  filled  by  reaction. 


190  PRACTICAL  HYDROTHERAPY. 

Immediately  under  the  stream  of  water  the  skin  becomes  blanched, 
followed  by  a  return  of  color  as  the  stream  moves  and  is  allowed  to 
fall  on  another  part,  probably  due  to  the  weight  or  concussion  of  the 
water  driving  the  blood  out  of  the  tissues.  When  reaction  takes 
place  the  blood-vessels  moderately  dilate,  retaining  what  is  called 
"tone"  or  tonic  reaction,  and  this  in  the  douche  is  noticeable  even 
in  the  smallest  blood-vessels.  For  the  maintenance  of  the  general 
circulation  there  is  nothing,  in  my  opinion,  comparable  to  the  cold 
douche.  The  quality  of  the  blood  and  the  number  of  corpuscles  are 
greatly  increased  after  a  bath.  The  douche  is  always  short  in  duration, 
thus  causing  it  to  act  as  a  general  tonic,  stimulating  the  heart's  action 
as  well  as  bodily  functions. 

Upon  respiration  the  cold  douche  immediately  causes  an  increased 
and  deepened  respiratory  act,  thereby  favoring  the  exchange  of  gases, 
with  an  increased  absorption  of  oxygen  and  elimination  of  carbonic 
acid  gas.  The  sudden  impingement  of  the  douche  causes  the  chest 
movements  to  be  of  much  greater  amplitude.  There  is  a  certain  amount 
of  sensation  of  gasping  and  restriction  of  breathing,  but  this  can  be 
easily  overcome  by  simply  opening  the  mouth  widely.  'With  the 
absorption  of  oxygen  there  is  an  increase  of  the  general  oxidative 
processes  of  the  body,  thus  reducing  the  complex  chemical  composi- 
tion of  toxins  to  those  simple  elements  that  are  easily  and  rapidly 
removed  from  the  body. 

Upon  metabolism  it  is  the  most  powerful  of  stimulants.  It  arouses 
functionation  to  the  highest  degree.  The  douche  is  eminently  a 
destructo-constructive  agent,  destroying  and  removing  waste  material, 
first  by  better  oxidative  processes  induced,  and  secondarily  by  the 
stimulus  it  gives  to  excretion.  By  the  better  destruction  and  elimina- 
tion of  toxic  waste  materials  physiological  processes  are  given  an 
opportunity  to  follow  the  natural  law  of  reconstruction  and  repair. 
Upon  chronic  metabolic  and  toxic  conditions  it  is  the  sitmmum  bonum. 
Not  only  does  it  increase  these  processes,  but  all  secretory  and  gland- 
ular organs  are  aroused,  so  that  the  secretion  is  greater  in  quantity  and 
better  in  quality.  Because  of  this  action  we  find  that  the  digestive  and 
assimilative  processes  become  more  effective,  the  appetite  is  increased, 
more  food  taken,  digested  and  assimilated.  The  lymph  current  is 
accelerated  in  the  channels  and  glands,  making  this  accessory  circula- 
tion more  effective  in  normal  tissue  regeneration.  Flesh  is  gained  and 
strength  renewed.  It  has  been  demonstrated  by  numerous  investigators 
that  elimination  is  greatly  increased  as  well  as  accelerated,  Strasser 
having  shown  that  all  waste  products  are  increasedly  removed  from  the 
body  by  the  douche.  Urea,  the  purin  bodies,  nitrogen,  uric  acid,  ex- 
tractives, etc.,  are  destroyed ;  the  specific  gravity  of  the  urine  is 
raised  and  the  liver  stimulated  to  destroy  gastro-intestinal  poisons. 

Upon    the    nervous    system    the    douche    exercises    an    influence 


Plate   113— Jet  Douche. 


Plate  114— Jet  Dorche  to  Spine;  Patient  Should  be  Farther  Away  and  Stream 
Straight  and  Powerful  as  in  Plate  113. 


Plate  115 — Scottish  or  Alternate  Douche. 


Plate  116— Scottish  or  Alternate  Douche  to  Spine;  the  Patient  Should  be 
Farther  Away  and  the  Streams  Straight  and  Powerful;  Shows  Method  of 
Holding  One  Stream  to  the  Side  While  the  Other  is  in  Use. 


THE  TECHNIQUE  OF  HYDROTHERAPY.  191 

equalled  by  no  other  procedure  in  the  domain  of  therapeutics,  and 
this  statement  is  made  with  a  full  appreciation  of  its  meaning.  The 
action  of  the  douche  upon  the  nervous  system  is  brought  about  by  the 
mechanical  and  thermic  impressions,  which  impinge  in  rapid  succession 
upon  the  peripheral  nerve  terminations  in  the  skin,  energetically  stim- 
ulating and  arousing  their  action.  In  the  action  of  the  douche  upon 
the  various  functions  of  temperature,  circulation,  metabolism,  etc., 
the  nervous  system  is  a  large  factor  in  the  production  of  both  the 
immediate  and  reflex  effects,  for  distant  influences  depend  entirely 
upon  nervous  impressions  and  are  dominated  by  their  action.  The 
reflex  influences  of  neural  action  are  enhanced  by  the  mechanical 
effect  of  the  impingement  of  water.  The  cold  douche  is  tonic  in 
action — a  general  invigorant,  producing  a  feeling  of  elation  and 
strength.  Immediately  after  its  use  sensation  is  enhanced  and  the 
skin  becomes  hyperesthetic.  Reflex  excitability  is  increased,  nerve 
centers  are  aroused,  especially  those  that  preside  over  neuro-cardio- 
vascular  structures.  In  its  impingement  upon  the  skin  the  douche 
gives  rise  to  tactile  and  other  sensations,  and  in  this  way  differs  from 
other  hydriatic  measures.  Pressure  influences  the  peripheral  nerves 
according  to  its  force,  its  extent  and  its  variations ;  it  sets  in  action 
myriads  of  reflexes,  both  afferent  and  efferent,  producing  thereby  in 
the  economy  a  new  balance  in  which  excesses  and  defects  in  function 
are  corrected  and  physiological  labor  divided.  That  it  increases  nerve 
force  and  nerve  regeneration  is  patent  daily  to  those  who  use  it  in 
their  practice,  it  being  equally  true  that  it  redirects  misspent  and 
irregular  nerve  force  into  reparative  and  functionating  channels.  The 
most  important  results  obtainable  in  hydrotherapy  are  secured  by  its 
use  with  less  tax  upon  the  neural  and  general  strength  than  by  any 
known  measure.  It  is  alterative,  vitalizing,  restorative.  Upon  the 
mental  functions  it  increases  their  activity,  acquisitive,  productive  and 
reproductive.  On  many  occasions  the  author  has  found  recourse  to  the 
douche  one  of  the  most  effective  and  satisfactory  methods  of  relieving 
mental  and  physical  fatigue  and  of  increasing  the  activity  of  his  higher 
mental  faculties. 

Upon  the  muscular  system  Maggiora  and  Vinaj  have  demonstrated 
the  marked  increase  in  muscular  power  following  the  douche,  together 
with  increased  capacity  for  work.  In  a  large  number  of  clinical  ex- 
periments made  by  the  author  upon  his  own  person  he  has  confirmed 
these  results ;  and,  furthermore,  it  has  a  peculiar  neuro-muscular 
refreshing  and  invigorating  effect,  felt  for  many  hours  after  its 
application.  The  motive  power  of  the  unstriped  muscular  tissue  is 
much  increased,  and  this  is  probably  one  of  the  many  reasons  why 
the  stomach,  intestines  and  other  viscera  are  made  more  active.  The 
muscular  coats  of  blood-vessels  respond  with  selective  activity  to  its 
action   in   connection   with  vascular   and   neural   effects.      By   the   in- 


192  PRACTICAL  HYDROTHERAPY. 

creased  muscular  action  heat   is   liberated,  toxins  and  acid   products 
squeezed  out,  followed  by  better  tissue  regeneration. 

Therapeutic  Application. — The  douche  is  rarely  used  in  acute  dis- 
eases, but  finds  its  greatest  field  in  chronic  affections  in  which  we 
wish  to  obtain  a  controlling  influence  over  circulation,  nutrition  and 
nerve  tone,  for  in  those  conditions  accompanied  by  anemia,  poor 
circulation,  malnutrition,  nervous  and  digestive  disorders,  and  against 
chronic  exudates  and  inflammations,  it  is  a  weapon  by  which  we  may 
successfully  attack  conditions  otherwise  impossible  to  reach.  In  chronic 
diseases  of  the  chest,  in  catarrhal  states  of  the  bronchi,  it  stimulates 
expectoration  and  facilitates  absorption,  this  latter  being  especially 
true  of  the  chronic  exudates  of  pleurisy  and  pneumonia.  In  func- 
tional and  inflammatory  diseases  of  the  entire  digestive  tract  results 
little  short  of  marvelous  are  obtained  by  a  course  of  douche  treatment. 
We  find  that  atonic,  nervous  and  secretory  disturbances  are  corrected, 
appetite  and  assimilation  improved,  flesh  gained. 

In  many  of  the  phychoses — melancholia,  neurasthenia — of  the  de- 
pressed and  general  type,  in  morbidity  with  introspection,  in  hysteria, 
in  many  cases  of  chronic  neuritis,  neuralgia,  sciatica  and  other  nervous 
affections,  there  is  no  weapon  equal  to  the  douche  in  restorative  power. 
In  the  chronic  rheumatic,  whose  toxin-laden  body  and  metabolic  pro- 
cesses are  so  warped,  the  douche  sets  in  vibration  the  entire  economy, 
and,  relieving  it  of  its  load,  soon  enables  Nature  to  assert  her  won- 
derful restorative  power.  Where  deposits  have  taken  place  in  the 
joints,  where  stiffness  and  ankylosis  without  destruction  have  taken 
place,  when  preceded  by  the  use  of  superheated  dry  hot  air  the  alter- 
nating or  Scottish  douche  is  the  method  par  excellence,  and  soon 
brings  about  lessened  pain  and  increased  mobility.  Where  the  con- 
dition popularly  known  as  "stiff  back,"  stiff  neck,  or  a  true  myositis 
exists,  where  there  is  muscular  soreness  after  an  acute  rheumatic 
attack,  the  douche  proves  an  absolute  panacea. 

In  those  cases  of  anemia  and  chlorosis  where  iron,  arsenic  and 
other  hematinics  fail  the  douche  alone  will  cure,  but  in  conjunction 
with  these  useful  drugs  the  hemoglobin  and  corpuscles  daily  increase, 
a  fact  frequently  demonstrated  by  me  from  actual  laboratory  ex- 
perience and  test.  Where  the  skin  is  dry  and  inactive  or  gray  and 
greasy-like,  due  to  improper  condition  of  its  circulation  and  glandular 
action,  nothing  so  quickly  removes  the  condition  as  the  stimulating 
thermic  and  mechanical  action  of  this  form  of  hydrotherapy.  In  the 
sedentary  and  in  those  who  are  unable  to  take  the  required  amount  of 
open-air  exercise,  a  short  course  of  this  form  of  hydrotherapy  once 
or  twice  a  year  or  once  or  twice  a  week  will  often  add  many  moons  of 
usefulness  and  activity  to  the  individual.  In  the  fashionable  and 
dissipated,  in  those  affected  with  "dyspeptic  livers,"  the  douche  soon 
rehabilitates  and  rejuvenates. 


/  ^K 


■■ 


■I 


Plate  117 — Shower  Bath. 


INFECTIOUS  DISEASES— FEVERS.  193 

It  can  be  used  even  in  feeble  cases,  for,  abstracting  no  heat  and 
favoring  speedy  reaction,  invigoration,  not  depression,  is  its  result. 
In  cases  of  inebriety  and  the  morphine  habit  the  douche  occupies  one 
of  the  highest  places  in  modern  methods  of  treatment,  relieving  the 
enslaving  thralldom  and  building  up  vitality. 

In  conclusion,  it  must  be  again  repeated  that  unless  reaction  is 
secured  the  aim  and  object  of  the  use  of  these  douches  is  defeated 
and  the  benefit  to  be  gained  thereby  lost. 

Contraindications. — Especial  care  should  be  exercised  in  the  use 
of  the  douche  in  the  aged,  in  those  suffering  from  respiratory  troubles, 
and  in  those  affected  with  arterial  sclerosis,  aneurism  and  atheroma. 
In  myelitis,  locomotor  ataxia,  acute  neuralgias,  multiple  neuritis,  gas- 
tric ulcer,  acute  gastro-intestinal  catarrh,  cystitis,  acute  rheumatism 
and  eruptive  diseases,  the  cold  douche  is  forbidden.  While  forbidden 
in  the  acute  phases,  in  the  chronic  cases  it  is  useful. 


CHAPTER  XI. 
SPECIAL  THERAPEUTICS;    INFECTIOUS  DISEASES;    FEVERS. 

The  author  realizes  the  shortcomings  that  are  to  be  found  when- 
ever one  attempts  to  condense  into  a  few  brief  lines  a  compact  state- 
ment of  a  disease  or  disorder,  but  he  feels  that  these  defects  are 
those  of  omission  rather  than  commission.  It  is  a  regret  of  his  that 
ample  space  could  not  be  given  to  the  full  and  technical  description 
of  each  disease  considered  in  this  section  of  therapeutics.  Were  this 
done,  the  size  and  scope  of  the  work  would  be  so  changed  as  to  pre- 
vent the  original  purpose  being  carried  out.  The  brief  descriptions 
are  merely  intended  to  refresh  the  memory  of  the  practitioner  and 
impress  the  student  with  the  salient  points  of  the  why  and  wherefore 
that  should  be  kept  in  mind  while  perusing  the  method  of  treatment. 
In  this  way  it  is  believed  a  better  grasp  of  the  subject  will  be  ob- 
tained by  those  who  refer  to  the  therapeutic  section  for  reference 
only.  To  some  it  may  seem  a  needless  thing  to  do,  but  the  author 
believes  that  it  will  prove  of  benefit  to  all  those  who  are  interested 
in  this  form  of  therapeutics. 

No  attempt  has  been  made  in  this  section  to  produce  any  more 
than  what  might  be  termed  ordinary  "good  English,"  and  it  may  pos- 
sibly seem  to  some  that  certain  words  have  been  much  overworked ; 
while  this  may  be  true,  the  author  feels  that,  in  spite  of  this,  he  has 
done  wisely  in  sacrificing  style  and  beauty  of  language  to  plain  simplic- 
ity and  absolute  clearness,  and  with  this  in  view  a  certain  formula  of 
expression,  as  it  were,  has  been  adopted,  in  order  that  the  practitioner 
and  student  may  very  easily  and  rapidly  grasp  the  meaning  and  in- 
terpret the  work.  Too  often  authors  are  condemned  for  lack  of  clear- 
ness in  directions,  that  are  fogged  because  they  fail  to  realize  that 
their  readers  do  not  comprehend  the  subject  with  the  facility  and 
ease  of  specialists  and  those  of  well-trained  minds.  The  simple  state- 
ment that  "so-and-so  is  good  in  this  disease"  has  been  avoided,  and 
an  endeavor  made  to  state  plainly,  simply  and  concisely  not  only 
what  method  to  use,  but  how  to  use  it,  what  treatment  should  follow 
this,  and  every  detail  necessary  for  the  tyro,  for  the  fact  remains 
that  nearly  98  per  cent,  of  medical  men  are  tyros  in  the  domain  of 
hydrotherapy.  The  author  has  so  often  experienced  this  dissatisfac- 
tion in  the  works  of  others  that  he  has  in  his  own  work  endeavored 
not  only  to  remind  the  reader  of  the  disease  in  hand  in  a  succinct 
manner,  with  a  brief  pathology,  but  has  tried  to  suggest  what  should 
(194) 


i.XFECTIOUS  DISEASES— FEVERS.  195 

be  first,  what  second,  etc.,  ad  infinitum.  It  has  been  his  rule  that 
wherever  several  lines  of  treatment  are  suggested,  to  indicate  which 
has  in  his  experience  proved  the  most  satisfactory  and  efficient;  for 
he  has  found  that  many  of  the  measures  reputed  to  be  of  value  have 
been  those  handed  down  in  books  of  this  character,  copied  and  re- 
copied  without  that  investigation  and  elimination  which  a  practical 
test  must  always  bear  to  the  theoretical  and  scientific  in  a  work  of 
this  character.  In  other  words,  it  has  been  his  aim  everywhere  to 
suggest  that  which  in  his  own  experience  has  proved  of  use  and 
value,  separating  the  wheat  from  the  chaff,  a  labor  of  some  difficulty 
but  of  vast  importance.  In  some  diseases,  such,  for  example,  as 
Asiatic  cholera,  he  has  been  compelled  to  accept  what  seems  to  him 
to  be  the  very  best  recommendation  of  several  authors  whose  experi- 
ence in  this  line  justifies  him  in  believing  their  suggestions  to  be  of 
value,  but  with  these  few  exceptions  he  has  hewn  strictly  to  the  line 
of  his  own  work,  trying  to  give  due  value  and  recognition  to  the  ex- 
cellent work  done  by  others  in  this  field. 

At  times  it  may  appear  as  though  there  were  a  great  similarity 
between  the  treatment  of  certain  diseases,  and  to  this  impeachment 
the  author  can  only  plead  that,  if  it  be  true,  it  is  simply  because  those 
treatments  have  been  found  equally  valuable  in  both  forms  or  phases 
of  diseased  tissue  or  function.  It  will,  however,  probably  be  seen 
upon  close  analysis  that  real  variations  exist,  although  at  first  glance 
they  might  not  appear  to  be  present,  for  it  will  oftentimes  be  found 
that  the  general  plan  of  treatment  having  for  its  object  the  upbuilding 
of  the  nutritional  state  of  the  patient  should  be  used  in  both  cases. 
the  variations  consisting  in  such  localized  treatment  as  the  individual 
disease  may  demand,  the  two  going  hand  in  hand,  thus  constituting 
a  difference. 

The  author  has  tried  to  avoid  being  too  dogmatic,  nor  has  he  in 
any  sense  reached  the  opinion  that  hydrotherapy  is  the  sole  and  only 
cure  to  be  used.  This  he  knozvs  to  be  true — that  hydrotherapy  is, 
of  all  single  therapeutic  methods,  in  his  opinion,  most  potent,  the 
remedy  par  excellence;  but  there  are  other  means  and  measures 
that  may  be  used  that  often  aid  and  assist  in  restoring  cases  to  health. 
It  were  foolish  not  to  adopt  them  in  conjunction  with  any  form  of 
rational  therapeutics,  and  to  this  end  he  has  frecjuently  suggested  a 
proper  dietary,  hygiene,  exercise,  and  other  treatment  that  would 
assist  and  be  supplementary  to  the  action  of  hydrotherapy.  The 
enthusiast  might  claim  that  hydrotherapy  alone  will  cure  disease, 
but  in  conjunction  with  other  methods  its  action  makes  cure  more 
certain,  and  as  the  aim  in  this  section  is  to  make  the  therapeutics  of 
water  easily  available,  successful,  and  in  many  instances  to  enhance 
other  treatment,  the  author  has  undertaken  the  task  of  enlarging  upon 
the  scope  of  his  work  in  order  to  make  it  more  accessible  and  effective. 


196  PRACTICAL  HYDROTHERAPY. 

Every  endeavor  has  been  made  to  steer  clear  of  the  bias  usually 
manifested  in  special  works  of  this  kind,  and  for  that  reason  a  clear 
conception  of  the  modern  idea  of  disease  and  of  the  general  methods 
by  which  the  case  is  managed  will  probably  prove  of  service. 

The  author  wishes  again  to  state  for  the  benefit  of  those  who 
never  read  prefaces  that  during  his  active  experience  of  eighteen 
years  he  has  not  been  in  any  sense  limited  to  the  use  of  hydrotherapy, 
but  has  had  at  his  beck  and  call  a  well-equipped  sanatorium,  trained 
nurses,  hygiene,  diet,  gymnastics,  massage,  mechanical  vibration,  elec- 
trification— galvanic,  faradic,  static,  sinusoidal  and  high-frequency; 
light  treatments  —  X-ray,  Finsen,  incandescent,  blue  —  all  that  the 
pharmacopeia  can  offer — and  for  this  reason  he  believes  he  is  all  the 
better  fitted  to  discerningly  separate  the  goats  from  the  sheep,  to 
estimate  accurately  the  value  of  hydrotherapy  as  compared  to  other 
measures  of  treatment ;  and  should  he  suggest  in  many  instances 
other  well-known  methods  in  conjunction  with  hydriatics,  it  is  be- 
cause experience  has  taught  him  their  paramount  value  in  these  cases. 

The  busy  practitioner  will  consult  this  section,  and  in  order  to 
save  time  each  section  is  made  complete.  He  will  find  diet  lists  and 
associated  measures,  as  well  as  some  medicines,  named,  the  combina- 
tion of  which  has  given  the  author  much  satisfaction.  In  the  index 
cross-references  may  prove  of  value  and  assistance.  In  conclusion, 
it  may  be  stated  that  a  study  of  the  preceding  sections  has  doubtless 
impressed  the  reader  with  the  necessity  for  the  correct  use  of  hydro- 
therapy in  disease.  He  must  have  realized  that  this  remedy  is  by 
all  odds  the  most  flexible  of  his  therapeutic  equipment,  an  agent  that 
may  be  found  in  any  home,  which  can  be  applied  in  hundreds  of 
conditions,  provided  that  the  temperature,  duration  and  mechanical 
effects  be  carefully  studied  in  relation  to  the  particular  case  in  hand. 

Simple  Fevers. 

There  come  under  the  observation  of  the  family  physician  many 
cases  of  simple  fever,  characterized  by  a  moderate  elevation  of  tem- 
perature, free  from  any  contagious  or  infectious  micro-organism, 
and  having  their  origin  from  divers  causes.  They  are  usually  of  short 
duration,  and  due  mostly  to  disorders  of  the  digestive  tract,  exposure, 
"catching  cold,"  or  over-exertion,  both  physical  and  mental.  They 
usually  present  fever,  gastro-intestinal  trouble,  headache,  lassitude, 
quick  tense  pulse,  increased  respiration,  hot  skin,  scanty  urine,  etc. 
In  these  cases  hydrotherapy  obtains  some  of  its  most  gratifying  re- 
sults, for  in  cottage  or  castle  the  means  are  at  hand.  Give  a  calomel 
and  aloin  purge,  and  restrict  diet.  In  sthenic  cases  do  not  feed.  Urge 
the  drinking  of  large  quantities  of  water,  to  the  extent  of  one  gallon 
per  diem,  which  may  be  flavored  with  fruits  to  suit  the  individual 
taste.     No  medicines  are  needed,  as  a  rule.     Commence  at  once  by 


INFECTIOUS  DISEASES— FEVERS.  197 

using  the  cold  sponge,  repeated  every  two  or  three  hours.  During 
the  interim  apply  the  cold  abdominal  compress  at  60°  F.  for  one  hour, 
and  repeat  after  each  sponging.  I  have  seen  much  benefit  result  from 
a  preliminary  use  of  the  hot  full  bath,  as  hot  as  can  be  borne,  fol- 
lowed by  wrapping  in  blankets  and  the  free  use  of  hot  water  in- 
ternally. Two  hours  later  use  the  cold  sponge  and  compress.  Where 
the  fever  is  not  promptly  controlled  by  these  measures,  we  can  com- 
mence the  use  of  the  full  cold  bath  every  three  or  four  hours  at  80°, 
with  friction  for  five  minutes,  decreasing  the  temperature  live  de- 
grees with  each  bath  and  increasing  the  duration  one  minute.  The 
great  advantage  of  these  measures  lies  not  alone  in  the  relief  of  the 
simple  febrile  process,  which  it  will  certainly  accomplish,  but  should 
the  fever  mask  an  infection  we  have  placed  our  patient  in  the  best 
possible  position,  having  increased  his  vital  resistance  and  become 
well  acquainted  with  his  reactive  power.  Hydrotherapy  is  the  method 
par  excellence. 

Typhoid  Fever. 

The  importance  of  fully  understanding  the  method  of  treating 
this  disease  cannot  be  overrated,  as  it  is  the  most  common,  most  im- 
portant, and  practically  the  ever-present  of  the  acute  infectious  dis- 
eases. Typhoid  fever,  because  of  its  large  mortality,  because  of  its 
frequency  and  amenability  to  hydriatic  procedures,  demands  that  the 
physician  have  a  clear  conception  of  the  essential  conditions  to  be 
met,  and  be  possessed  of  all  therapeutic  resources  to  meet  the  re- 
quirement. Typhoid  or  enteric  fever  is  an  acute  infectious  disease, 
due  to  a  specific  toxin,  generated  by  the  typhoid  or  Eberth  bacillus, 
characterized  by  symptoms  referable  to  the  nervous  (headache,  stu- 
por, delirium)  and  gastro-intestinal  systems  (red  tongue,  becoming 
dry  and  brown,  abdominal  tenderness,  diarrhea,  tympanites),  a  pe- 
culiar eruption  upon  the  skin,  rapid  prostration  and  slow  convales- 
cence. The  constant  lesions  are  found  in  Peyer's  patches,  the  mesen- 
teric glands  and  spleen.  The  disease  is  excited  by  the  entrance  of  the 
bacillus  into  the  alimentary  tract  by  means  of  contaminated  water, 
milk,  ice,  meat,  celery,  lettuce,  or  other  substances.  Flies  frequently 
aid  in  disseminating  the  disease.  Peyer's  patches  become  infiltrated, 
then  necrose,  soften  and  slough,  leaving  ulcerated  surfaces,  which 
in  recovery  are  succeeded  by  cicatrization.  The  spleen  undergoes  anal- 
ogous changes,  except  ulceration,  and  the  heart,  liver  and  kidneys 
are  the  seat  of  parenchymatous  or  glandular  changes.  From  the  pro- 
dromal to  the  convalescent  stage  five  essential  points  are  of  great 
interest. 

1.  The  presence  and  persistence  of  nervous  symptoms,  such  as 
malaise,  headache,  insomnia,  delirium,  stupor,  coma,  "typhoid  state," 
etc.,  etc. 


198  PRACTICAL  HYDROTHERAPY. 

2.  A  weakening  of  heart  action  and  a  rapid  pulse. 

3.  An  elevation  of  temperature. 

4.  Failure  of  elimination. 

5.  'Marked  mortality. 

Of  the  complications,  hemorrhage  and  perforation  are  the  most 
important.  Mortality  is  variously  estimated  from  14  to  25  per  cent, 
under  the  '"expectant"  treatment,  which  percentage  truly  assumes  an 
"expectancy"  unpleasant  to  contemplate.  Under  the  various  "modi- 
fied" bathing  systems,  I  am  convinced  a  fair  average  is  7.5  per  cent. 
While  Brand1  has  reported  2,150  cases  treated  by  his  strict  method, 
commencing  before  the  fifth  day,  with  no  deaths,  and  has  collected 
from  German  sources  19,017  cases  treated  by  "all  kinds  of  cold  baths" 
with  a  percentage  of  7.8;  while  many  American  practitioners  have 
small  numbers  of  cases  with  no  deaths,  still  it  may  be  said  that  a 
rough  general  percentage  of  deaths,  where  the  strict  method  has  been 
employed,  ranges,  as  far  as  I  can  estimate  same  from  literature  and 
personal  information,  between  3  and  4  per  cent.  This  difference  of 
three  or  four  lives  per  hundred  were  enough  to  induce  the  more  fre- 
quent use  of  the  full  method.  The  Medical  Times  (  1903)  says  that 
no  drugs  are  employed  at  Johns  Hopkins  Hospital,  where  they  have 
the  largest  number  of  cures. 

With  this  short  and  condensed  epitome,  we  are  ready  to  consider 
the  treatment  of  this  disease. 

The  patient  should  be  placed  in  bed  in  a  quiet,  well-ventilated 
room,  the  temperature  of  which  should  be  kept  between  60°  and  65° 
F.  Avoid  draughts.  An  intelligent  and  painstaking  nurse  is  an  es- 
sential element  in  the  successful  handling  of  the  case,  but  frequently 
this  desideratum  cannot  be  obtained,  and  an  obedient  layman  must 
be  substituted.  The  bed  is  best  single,  of  metal,  with  woven  wire 
mattress,  two  blankets,  a  plentiful  number  of  sheets  and  pillow 
covers.  The  drinking-water  should  be  boiled  and  then  cooled  in  a 
refrigerator  kept  in  an  adjoining  room,  thus  protecting  the  patient 
from  further  infection.  The  most  scrupulous  cleanliness  must  be  ob- 
served, the  bed-pan  being  used  through  the  entire  disease  and  steril- 
ized with  boiling  water  after  its  use.  The  discharges  should  be  dis- 
infected with  a  solution  of  chloride  of  lime  or  formaldehyde.  All 
utensils  must  after  use,  be  washed  in  the  disinfectant  solution  and 
afterward  in  very  hot  water.  The  nurse  should  protect  herself  by 
using  no  food,  water,  glasses,  etc.,  that  are  used  in  the  room,  and 
should  cleanse  her  hands  and  forearms  scrupulously  after  each  con- 
tact. Discharges  after  disinfection  are  best  buried.  Linen  must  be 
boiled  before  washing.  Diet  should  be  liquid  and  consist  of  diluted 
milk,  broths,  buttermilk,  sour  milk  (yogurt  bacillus),  and  albumen 
water,  which  may  be  flavored  with  lemon  or  orange,  preferably  the 

1    Deutsche    med.    Woch.,    1887. 


INFECTIOUS  DISEASES— FEVERS.  199 

latter.  Milk  is,  by  common  consent,  the  best  diet,  and  is  more  pal- 
atable and  useful  diluted  with  Vichy. water,  though  lime  water  may 
be  used.  Salt  must  be  added.  For  a  change  it  may  be  peptonized  or 
koumyss  used.  Oyster  stew,  minus  the  oysters,  is  a  palatable  method. 
Five  ounces  is  sufficient.  I  believe  in  the  free  administration  of  cold 
sterile  water — as  much  as  a  half-gallon  in  the  twenty-four  hours — as 
it  quenches  the  thirst  and  removes  waste  products  and  toxins.  Cushing 
and  Clark2  gave  this  amount  in  small  doses,  eight  ounces  every  half- 
hour  when  awake,  while  every  two  hours  six  ounces  of  milk  and  six 
ounces  of  albumen  water  were  administered.  During  the  night  these 
latter  were  given  once  or  twice.  They  noticed  there  was  less  nursing, 
fewer  complications  and  no  deaths.  Polyuria  was  marked,  closely 
corresponding  to  the  fluid  ingested.  Headache,  apathy,  restlessness, 
nocturnal  delirium  and  deafness  markedly  lessened.  The  tongue  and 
mouth  kept  clean  and  moist,  nausea  was  infrequent,  fever  remissions 
present.  Toxemia  was  notably  diminished.  The  author  has  found 
in  fevers  that  flavoring  the  water  ingested  with  fruit  juices,  lemon, 
orange,  apple,  raspberry,  etc.,  enables  the  patient  to  drink  more 
freely,  in  larger  quantities,  while  at  the  same  time  these  juices  act 
as  mild  antiseptics  and  possess  a  fair  amount  of  nourishment.  I  am 
not  much  of  a  believer  in  whisky  except  in  emergencies,  and  believe 
heart  action  is  better  sustained  by  other  measures,  as  we  shall  see 
later,  though  Baruch  administers  whisky  or  brandy  just  before  the 
Brand  bath.  One  should  aim  to  nourish  and  bathe  at  or  about  the 
same  time,  in  order  to  avoid  fatiguing  and  disturbing  the  patient  too 
often.  It  is  doubtless  a  good  general  rule  to  commence  treatment 
with  a  calomel  purge. 

Hydriatic  procedures  should  be  at  once  utilized,  before  even  the 
diagnosis  is  made,  for  no  harm  can  be  done  bathing  febrile  patients, 
and  much  danger  accrues  from  delay.  If  in  doubt  as  to  diagnosis, 
we  can  commence  the  use  of  the  cold  sponge.  In  order  to  be  effective 
the  surface  of  the  body  must  be  made  quite  wet.  Commence  the 
sponge  with  water  at  a  temperature  of  80°  F.,  and  reduce  the  tem- 
perature five  degrees  each  successive  application  until  60°  F.  is 
reached.  This  ablution  may  be  repeated  every  two  hours  if  the  tem- 
perature registers  100°  to  101°  F.  One  great  advantage  of  this  pre- 
liminary hydrotherapeutic  treatment  is  the  preparation  it  gives  the 
patient  and  the  clear  index  we  obtain  of  his  reactive  capacity. 

If  now  the  diagnosis  is  made  unequivocally  of  typhoid,  the  prac- 
titioner has  four  methods  to  select  from — to  continue  the  cold  sponge 
and  compress  already  instituted;  the  tepid  full  bath  with  friction  at 
85°  to  80°  F.  for  fifteen  to  twenty  minutes,  followed  by  the  abdominal 
compress  at  60°  F.  for  one  hour,  change  once  or  twice ;  the  neutral 
bath  at  95°  F.  for  twenty  to  thirty  minutes,  with  friction,  followed  by 

2  American  Journal  of  the  Medical   Sciences,   March,   1905. 


200  PRACTICAL  HYDROTHERAPY. 

the  abdominal  compress  at  60°  F. ;  the  full  Brand  bath.  I  do  not 
believe  in  or  recommend  packs. 

The  time  has  come  when  the  hydriatist  must  speak  with  no  small 
voice  concerning  the  use  of  the  cold  bath,  experience  having  fully 
determined  its  efficiency.  The  author  has  never  been  the  victim  of 
typhoid,  but  should  he  become  so  infected  would  not  hesitate  one  mo- 
ment upon  the  method  herewith  outlined.  The  strict  method  laid 
down  by  Brand  and  followed  to  the  letter  by  medical  men  who  mould 
opinion  in  Europe  and  America  is  the  mainstay  of  the  progressive, 
honest  and  painstaking  practitioner  of  to-day.  Cabot  has  shown 
the  great  value  of  the  sponge  as  given  in  the  Massachusetts  General 
Hospital,  of  its  revivifying  influence  and  its  temperature-reducing 
power.  Taken  as  a  rule,  the  patients  do  not  seriously  object  to  the 
ablution  or  sponge  at  65°,  50°  or  40°  F.,  while  many  object  to  the 
strict  Brand  method.  By  the  strict  Brand  method  I  mean  the  admin- 
istration of  a  cold  full  bath  at  65°  F.  for  fifteen  minutes,  accompanied 
by  friction,  whenever  the  temperature  per  rectum  reaches  102.5°,  and 
described  in  detail  on  another  page. 

It  must  be  said  with  regret  that  this  method  grows  slowly  with  the 
American  profession.  It  is  absolutely  essential  to  use  some  method 
at  the  earliest  possible  moment,  and  a  plan  that  frequently  works  well 
is  to  start  the  patient  with  a  full  bath  at  90°  F.,  three  to  five  minutes' 
duration,  using  friction ;  decrease  the  temperature  two  degrees  for  the 
next  five  baths  and  lengthen  the  time  tzuo  minutes  until  the  bath  is  of  a 
temperature  of  80°  and  fifteen  minutes'  duration;  drop  one  degree 
for  the  next  five  baths,  continuing  them  fifteen  minutes  until  75° 
is  reached,  and  if  your  patient  and  family  do  not  object,  drop  in  the 
same  manner  to  70°  and  65°  F.  Never  forget  to  use  friction,  though 
it  must  not  be  too  severe.  In  very  old  and  very  young  persons,  90° 
F.  for  ten  or  fifteen  minutes  is  usually  better  than  the  colder  bath, 
which  they  stand  badly,  for  children  have  larger  skin  area  to  their 
weight  and  feebler  heat-producing  powers.  It  is  not  a  bad  practice 
to  once  daily  cleanse  the  skin  of  the  patient  by  the  use  of  green 
soap  just  before  giving  one  of  the  baths.  These  baths  should  be  re- 
peated four  times  daily.  Many  authors  find  the  cool  enema  at  75° 
to  80°  F.,  once  or  twice  daily,  an  adjunct,  emptying  the  bowels,  re- 
moving germs  and  toxins.  Thompson3  says  that  if  the  patient  shivers 
after  the  bath,  give  Hoffmann's  anodyne,  dr.  i  in  aqua  camphorse 
oz.  i.  If  these  measures  are  followed,  and  the  bath  method  cautiously 
introduced,  little  objection  will  be  encountered,  and  Americans,  pro- 
fessional and  lay,  gradually  educated  to  what  some  have  very  unjustly 
termed  "barbaric  procedures."  As  the  maximum  febrile  temperature 
begins  to  decline  the  temperature  of  the  baths  should  be  gradually 
raised  to  85°  or  90°  F.     During  the  entire  course  of  the  disease  the 

3   Medical   News,   April   8,    1907. 


Plate    119— Brand    Bath— First   Stage    (Cohen's   "Physiological    Therapeutics"). 


Plate  120-Brand  Bath-Second  Stage  (Cohen's  "Physiological  Therapeutics";. 


INFECTIOUS  DISEASES— FEVERS.  201 

heart  may  be  energized,  the  circulation  improved,  and  some  reduc- 
tion in  temperature  secured  by  the  judicious  use  of  the  ice-bag  over 
the  heart  for  fifteen  to  twenty  minutes  every  three  or  four  hours. 
Its  use  should  never  be  omitted. 

No  matter  what  method  is  employed,  the  judicious  use  of  the 
cold  compress  enhances  the  effect  of  the  hydriatic  procedure  adopted. 

A  discussion  at  this  point  of  certain  features  of  the  treatment 
may  not  be  amiss : 

1.  The  nervous  system  in  its  entirety,  from  prodrome  to  con- 
valescence, feels  the  brunt  of  the  attack.  This  is  shown  by  the  malaise, 
headache,  insomnia,  somnolence,  tremor,  subsultus,  delirium  and  coma. 
For  this  reason  the  influence  exerted  by  hydriatics,  and  especially 
the  Brand  bath,  places  them  at  the  fore  as  the  weapon  par  excellence, 
and  those  who  know  from  experience  rely  upon  it.  so  exact  and 
scientfic  are  the  results.  What,  then,  is  the  result  of  hydriatic 
applications?  Instead  of  the  toxins  sweeping  over  the  nervous 
system  and  drowning  it,  the  nerve  centers,  lower  and  higher,  are 
aroused  from  their  lethargy  by  the  powerful  sensory  impressions 
made  upon  the  peripheral  nerves,  conveyed  from  the  skin  to  the 
ganglionic  centers  first,  then  to  the  brain,  and  as  a  direct  result 
general  vital  resistance  is  increased.  In  fact,  it  is  a  nerve  tonic  in 
febrile  conditions  analogous  to  the  tonic  action  of  the  cold  douche 
in  chronic  maladies.  liy  preventing  and  overcoming  the  nervous 
symptoms  it  removes  some  of  the  most  distressing  and  alarming  con- 
ditions, and,  in  addition,  tends  to  shorten  the  grave  period  of  the 
disease.  Its  action  in  dilating  the  peripheral  blood-vessels  causes  a 
powerful  fluxion  from  the  brain,  cleansing  it  from  the  accumulated 
poisons  and  giving  the  nerve  centers  a  chance  for  rest  and  recupera- 
tion. Great  comfort,  quiet  and  refreshing  sleep  are  indications  of 
this  bath's  favorable  action  upon  the  nervous  system,  and  the  influ- 
ence of  the  bath  upon  nerve  action  in  its  turn  increases  cardiac  action, 
as  shown  by  slower  and  better  pulse.  One  of  the  most  gratifying 
effects  is  the  clearer  intellect,  thus  enabling  the  patient  to  intelligently 
aid  in  the  treatment,  a  factor  of  no  mean  importance. 

2.  In  all  the  range  of  medicine  and  surgery  cardiac  action  and 
pulse-rate  are  of  vast  importance,  and  their  condition  and  consider- 
ation is  one  of  the  first  problems  the  practicing  physician  takes  up  at 
the  bedside.  Like  the  spectre  of  Banquo's  ghost,  the  fear  of  heart 
failure  hovers  around  the  bedside  of  each  and  every  case  in  infectious 
disease,  and  any  method  by  which  this  may  be  averted,  by  which 
the  pulse  and  cardiac  action  are  strengthened,  is  a  welcome  addi- 
tion. In  the  Brand  bath  we  have  a  therapeutic  measure  second  to 
none. 

Let  us  see  why  the  heart  and  pulse  weaken  in  typhoid  fever.  The 
cardiac    muscle    and    the    blood-vessels    connected    with    it    energize 


202  PRACTICAL  HYDROTHERAPY. 

through  the  action  of  several  mechanisms,  the  most  important  of 
which  are  its  nervous  connections  with  the  cerebrum  and  spinal  cord, 
the  ganglia  in  the  heart,  along  the  blood-vessels  and  in  the  muscular 
tissue  itself.  All  of  these  factors  are  under  the  influence  of  the  vaso- 
motor centers  and  nerves.  Enfeeblement  and  later  failure  results 
from  the  action  of  the  toxins  upon  the  central  and  ganglionic  nervous 
systems,  and  a  direct  influence  upon  the  muscular  tissue,  producing 
parenchymatous  degeneration.  As  a  result,  we  have  feeble,  rapid 
heart  action,  loss  of  tension  and  filling  of  the  peripheral  blood- 
vessels. If  we  are  to  believe  the  experiments  of  Paessler  and  Rhom- 
berg,  this  is  due  to  the  influence  of  the  toxin  upon  the  vasomotor 
centers  within  the  medulla  oblongata.  There  is  no  denying — and 
every  observer  confirms  the  fact — that  in  the  bath  of  Brand,  accom- 
panied by  friction,  we  have  an  agent  by  which  the  vasomotor  centers 
are  stimulated,  cardiac  nerve  action  enhanced,  muscle  tone  increased, 
and  blood  pressure  raised,  all  of  which  are  clearly  shown  in  clinical 
work  by  a  fuller,  slower  and  better  pulse.  Its  action  upon  the  vaso- 
motor-neural  mechanism  is  brought  about  through  sensory  impressions 
conveyed  from  the  skin  to  the  nerve  centers,  arousing  them  to  action, 
and  secondarily  by  the  refreshing  and  invigorating  influence  that  the 
contact  of  the  cooled  blood  has  upon  the  nerve  centers,  heart  muscle 
and  blood-vessels.  As  we  shall  later  note,  the  benefit  of  eliminating 
toxins  must  be  taken  into  account.  The  bedside  observer  will  be 
quick  to  note  that  the  pulse  may  even  be  small,  but  it  has  regained 
its  power  and  possesses  that  feeling  of  normal  tension  pleasant  to 
the  finger-tips  of  physicians. 

3.  In  a  careful  review  of  the  extensive  literature  of  hydrotherapy 
in  acute  infectious  diseases,  the  author  has  been  struck  by  the  fact 
that  so  many  writers  seem  to  insist  that  the  temperature-reducing 
feature  is  the  essential  aim  of  this  method,  when,  in  fact,  it  is  sub- 
sidiary, though  none  the  less  very  valuable.  It  is  doubly  surprising 
when  we  find  such  masters  as  Brand,  Yogel,  YYinternitz.  Popeschal, 
Liebermeister,  Strumpell,  Ziemssen,  Baruch,  Kellogg,  ^"ilson,  Hare, 
Osier,  Tyson,  Delafield,  Sihler,  Welch,  Loomis,  Shattuck  and  a  host 
of  others,  men  whose  experience  is  large,  urging  an  entirely  different 
view. 

Two  factors  cause  elevation  of  temperature — increased  heat  produc- 
tion and  lessened  dissipation.  These  are  governed  by  nerve  centers 
whose  function  it  is  to  regulate  those  influences  which  in  health  and 
under  ordinary  conditions  would  not  affect  the  body  or  cause  a  rise  in 
temperature.  Heat  production  is  increased  by  the  presence  of  the 
patient  in  a  warm  medium,  by  muscular  contractions,  voluntary  or 
involuntary,  by  the  contraction  of  peripheral  blood-vessels  and  mental 
effort.  Heat  dissipation  depends  largely  upon  the  condition  of  the 
blood-vessels   in  the   skin    (contraction)    and   the  temperature  of  the 


Plate  121 — Brand  Bath — Third  Stage    (Cohen's  "Physiological  Therapeutics"). 


Plate  122 — Brand  Bath — Fourth  Stage  (Cohen's  "Physiological  Therapeutics"). 


INFECTIOUS  DISEASES— FEVERS.  203 

medium  that  surrounds  the  cutaneous  surface.     In  the  aDove  tw<    sen- 
tences lies  the  full  principles  upon  which  the  Brand  bath  acts. 

Let  us  see  what  take-  place.  The  patient  in  a  medium  of  water  at 
65  F.  would  suffer  practically  no  heat  reduction  unless  friction  was 
used,  the  loss  of  heat  in  the  skin  being  compensated  by  muscular  con- 
tractions. By  the  use  of  friction,  however,  the  peripheral  circulation 
is  much  stimulated,  the  blood-vessels  relax  and  dilate  and  the  blood 
coming  in  contact  with  the  cold  medium  give-  up  its  heat.  The  cooled 
blood  returning  to  the  interior  is  replaced  by  the  heated  blood,  and 
reduction  of  temperature  is  the  result.  By  friction,  chilling  and 
tremor  are  prevented,  and  a  factor  in  heat  production  is  thus  elim- 
inated. It  is  now  apparent  why  the  bath  must  have  a  duration  of 
some  time  in  order  to  accomplish  its  results,  and,  further,  why  fric- 
tion, with  its  reactionary  effects,  is  to  be  avoided  after  the  bath. 

Temperature  elevation  is  not  the  bugaboo  it  was  formerly  be- 
lieved to  be,  present   investigation  leading  one  to  believe  it  to  be  a 

lewhat  conservative  process  en  the  part  of  Nature  in  her  endeavor 
to  combat  the  poison  and  destroy  the  cause  of  morbid  action.  By 
the   bath  the  reparative   forces   are  brought  out  and  the   destruction 

well  as  elimination  of  toxins  hastened.  This  is  accomplished  by 
means  of  no  toxic  substances  or  antipyretics  introduced  into  the  circu- 
lation, which,  as  Baruch  sarcastically  remarks,  "enable  the  patient  to 
die  without  any  elevation  of  temperature."  The  evaporation  of  water 
from  a  surface  reduces  temperature,  a  fact  that  is  utilized  in  far 
Eastern  climes  to  cocl  water.  For  this  reason  the  patient  is  allowed 
to  lie  some  little  time  in  the  sheet  and  blanket,  being  later  gently 
dried. 

"A  death  from  typhoid  in  the  first  week  from  excessive  tempera- 
ture or  failure  of  the  nervous  system  is  rarely  observed;  the  chief 
danger  lies  in  the  infective  process,  which  undermines  the  system 
slowly  but  surely.  To  meet  this  danger,  the  cold  bath  is  our  shield 
and  ever-ready  weapon.  In  mild  cases  the  rise  of  temperature  and 
pulse  is  readily  combated  by  it.  the  resisting  power  of  the  disease 
being  feeble.  Hence  the  temperature  rises  only  at  long  intervals  to 
103°  F.,  but.  whenever  it  does  so  rise,  the  rule  should  be  inexorable; 
the  bath  must  be  administered.  Clinical  experience  demands  it.  and 
if  we  would  receive  its  benefits  we  must  obey  the  behest.  The  more 
nearly  we  approach  the  high  standard  of  strict  bathing,  the  more 
nearly  may  we  approach  the  low  mortality."     (  Baruch/) 

The  influence  of  this  bath  upon  temperature  is  to  reduce  same 
during  the  first  week  or  ten  days  only  a  fraction  of  a  degree,  but  by 
the  end  of  the  second  week  we  may  look  for  a  drop  of  from  two 
to  five  degrees  after  each  bath,  rising  again  in  two  to  three  hours  to  its 
former  level. 

Febrile  disturbances  have  two  accompaniments  always — hot  dry 
skin   and  a   concentrated   and   diminished   urine.       It   is   true   of    the 


204  PRACTICAL  HYDROTHERAPY. 

application  of  water  in  general  as  well  as  in  particular  to  the  disease 
in  hand  that  these  conditions  are  met  and  overcome  by  cold  applica- 
tions. To  the  tactits  eruditus  the  hot,  dry  and  pale  skin  of  the 
febrile  state  is  a  true  index  to  throw  open  the  blood-vessels — "open 
the  pores  and  produce  perspiration."  As  we  have  already  dwelt  upon 
the  dilatation  of  blood-vessels  and  increased  skin  activity  due  to  the 
cold  bath  and  friction,  it  is  only  necessary  to  state  further  that  with 
the  softening  and  removal  of  the  debris  of  dead  epithelium,  the  skin 
becomes  soft,  its  glands  proceed  to  act  and  the  floodgates  of  the 
cutaneous  surface  are  thrown  open  for  the  elimination  of  toxins, 
which  we  have  shown  in  previous  chapters  is  quite  large. 

The  urine,  diminished  in  quantity,  loaded  with  toxins  of  the  disease 
and  the  detritus  of  tissue  metabolism,  gives  a  fair  index  of  what  must 
be  the  general  condition  of  the  circulating  medium.  There  seems  no 
dispute  that  these  toxins  and  waste  products,  many  of  which  are 
deadly,  in  turn  enhance  the  general  condition  and  increase  the  tem- 
perature. The  ingestion  of  large  quantities  of  water  favors  the  hydra- 
tion of  these  poisons,  rendering  them  more  soluble,  while  the  Brand 
bath,  by  increasing  the  action  of  the  kidney,  favors  their  prompt 
elimination.  As  a  corollary,  the  respiration  being  increased,  better 
C02  exhalation  and  oxygen  absorption  take  place,  and  in  the  presence 
of  sufficient  oxygen  these  toxins,  leucomaines,  hydrotoxin  products 
are  consumed,  rendered  more  soluble  and  easily  eliminated  through 
the  better  circulating  blood  current.  Here  we  do  not  depart  from 
general  hydriatic  principles  of  physiological  action,  but  find  that  in 
acute  infectious  processes  the  same  rule  holds  good.  Cutaneous, 
respiratory  and  urinary  increase  of  elimination  is  the  direct  result  of 
the  hydriatic  treatment. 

5.  The  mortality  of  typhoid  fever  under  expectant  treatment  prior 
to  1870  was  high,  ranging  from  24.2  to  32.2  per  cent.,  but  in  the  past 
decade  it  has  fallen  to  between  14  and  17  per  cent.  These  percentages 
are,  I  believe,  fair,  and  are  the  result  of  a  search  through  a  vast 
amount  of  ancient  as  well  as  current  literature.  Even  under  "com- 
promise" methods  the  mortality  has  dropped,  until  we  can  fairly 
state  that  it  has  reached  8  to  10  per  cent.,  while  under  the  strict  Brand 
method  the  death-rate  ranges  from  0  to  7.S,  a  fair  average  from  all 
sources  being,  in  my  opinion,  3  to  4  per  cent.  These  figures  have 
been  time  and  again  presented  to  the  profession,  and  in  spite  of  all 
this  the  full  method  is  not  as  freely  adopted  as  it  should  be.  There 
is  in  the  American  mind  an  inherent  repugnance  to  cold  water  even 
in  robust  health,  a  shrinking  and  shirking  that  is  remarkable  to  those 
who  love  its  use.  For  this  reason  and  for  sentimental  nonsense  the 
patient  and  his  family  would  run  the  risk  of  the  loved  one's  death 
rather  than  submit  him  to  the  "terrible  ordeal"  of  a  cold  bath.  It  is 
interesting  to  note  the  conclusions  of  all  users  of  this  method  that 


INFECTIOUS  DISEASES— FEVERS.  205 

"after  a  few  baths  the  patient  made  no  objections."  It  is  much  less 
pathetic  to  place  a  patient  in  a  tub  of  cold  water  than  to  place  him 
in  a  grave.  If  people  will  submit  to  the  shock,  anesthesia  and  other 
suffering  of  a  surgical  operation  to  save  the  lives  of  their  dearly 
beloved  ones,  why  should  they  shrink  from  the  Brand  bath?  It  is  the 
idea  of  how  disagreeable  a  cold  bath  must  be.  The  method  is  easy 
to  learn,  and  if  in  the  Philadelphia  and  other  hospitals  colored  men 
and  women  can  learn  to  give  these  baths,  certainly  the  Caucasian 
should  regret  to  be  classified  below  the  descendants  of  Ham. 

Secondarily,  as  a  result  of  increased  cardiac  action,  increased 
arterial  tension,  better  nerve  action  and  oxidation,  the  functions  of 
the  internal  viscera  are  improved.  This  is  observed  in  better  appetite 
and  capacity  on  the  part  of  the  stomach  to  digest  the  food  taken. 
Many  foreign  observers  have  so  often  found  capacity  in  this,  line  as 
to  question  whether  it  was  not  advisable  to  give  a  semi-solid  diet;  in 
fact,  the  control  of  the  patient  in  this  respect  may  be  necessary. 
Better  conditions  prevail  in  the  bowel  in  that  diarrhea  and  tympanites 
are  much  reduced  by  these  baths.  The  liver  plays  an  important  role, 
for,  standing  as  it  does  at  the  doorway  of  the  portal  circulation,  it 
is  flooded  with  toxins  that  arise  from  the  viscera.  Its  circulation 
becomes  weak,  the  organ  congested  and  subject  to  degeneration.  The 
increased  fluxion  of  blood  which  the  bath  sets  up  empties  the  vessels 
of  the  stagnated  and  half-paralyzed  liver,  energizes  to  renewed  activity 
the  poison-benumbed  ganglia  which  control  it,  arouses  to  its  work  the 
hepatic  cell,  thus  renewing  all  the  functions  and  maintaining  the  in- 
tegrity of  this  most  important  viscus.  In  fevers  the  number  of 
corpuscles  is  greatly  diminished,  consequently  the  oxygen-carrying 
power  of  the  blood  is  proportionately  lessened.  It  is  interesting  in 
this  connection  to  recall  the  fact  that  the  white  corpuscles  are  in- 
creased in  number  to  a  greater  extent  than  are  the  red  by  cold 
applications.  The  leucocytes  play  an  important  role  as  defenders  of 
the  body,  in  destroying  microbes,  while  the  serum  destroys  bacterial 
toxins.  What  other  agent  known  to  man  is  capable  of  rendering 
such  service  as  this?  Acetanilid  and  antipyretics  of  all  sorts  diminish 
the  blood  count  instead  of  increasing  it,  and  thus  greatly  lessen  the 
oxidizing  power  of  the  blood. 

Another  most  important  service  which  the  cold  bath  renders  the 
fever  patient  is  the  amelioration  of  his  discomforts.  'Medical  men 
who  have  been  subjected  to  this  method  of  treatment  while  suffering 
from  typhoid  and  other  fevers  have  unanimously  testified  to  the 
comfort  which  it  secures.  The  brown,  thickly  coated,  swollen  and 
parched  tongue,  the  sordes-covered  lips  and  teeth,  the  catarrh  of  the 
stomach  and  bowels,  the  tympanites,  hemorrhage,  flatulence,  exhaust- 
ing diarrhea,  pneumonia,  myocarditis,  headache,  mental  stupor,  ner- 
vousness,    apprehension,     paralysis,     the     cadaverous,     ocher-colored 


206  PRACTICAL  HYDROTHERAPY. 

appearance  of  the  patient,  are  almost  never  seen  when  the  cold  bath 
has  been  administered  from  the  very  beginning.  In  spite  of  all  these 
advantages,  it  is  often  difficult  to  secure  the  consent  of  the  family, 
but  the  suggestion  of  Dr.  Barker4  may  be  adopted,  that  to  "overcome 
this  prejudice  he  sends  some  missionary  literature  or  sends  the  friends 
of  the  patient  to  some  family  in  which  the  bath  has  been  successfully 
used.  After  a  few  baths  no  argument  is  needed.  He  begins  with  a 
temperature  of  90°,  to  secure  confidence,  and  gradually  lowers  it." 

It  is  frequently  urged  that  it  is  difficult  to  get  nurses  to  perform 
the  large  amount  of  labor  in  the  bath  treatment,  but  the  nurse  who 
has  watched  and  cared  for  a  case  of  typhoid,  with  delirium,  stupor, 
involuntary  defecation  and  urination,  will  gladly  accept  the  toil  and 
worry  of  the  bath  treatment  as  less  trying. 

Hydrotherapy  is  entirely  safe  when  judiciously  employed,  and  its 
use  is  free  from  serious  objection.  Brand  says  that  all  cases  coming 
under  treatment  before  the  fifth  day  should  recover.  The  use  of 
medicinal  antipyretics  is  attended  by  many  objectionable  features.  In 
the  use  of  antipyrine  and  other  temperature-lowering  drugs  we  have 
to  deal  with  a  depression  usually  followed  by  an  elevation  to  a  point 
higher  than  before.  The  depression  of  temperature  is  short,  the  heart 
action  is  weakened,  elimination  and  oxidation  become  defective,  being 
followed  by  a  general  lessening  of  mental  and  nervous  power.  In  my 
opinion  these  antipyretic  drugs  should  never  be  used  or  substituted 
for  the  bath  treatment. 

The  use  of  alcohol  before  or  after  the  bath  should  be  here  dis- 
cussed. It  is  not  maintained  that  preparation  for  the  cold  bath  is  not 
needed,  but  rather  that  there  are  better  methods  than  by  the  use  of 
alcohol.  The  ideal  preparation  is  to  be  found  in  the  application  of 
heat.  If  alcohol  in  any  way  aids  reaction  it  is  not  by  augmenting  the 
activity  of  the  nerve  centers,  but  by  encouraging  the  relaxation  of 
the  surface  vessels.  Far  better  is  it  to  start  early  and  by  so  doing 
increase  the  reactive  power  of  the  patient,  or  use  temperatures  which 
do  not  occasion  the  patient  so  much  discomfort  or  worry.  I  have  seen 
this  obviated  in  fevers  and  other  conditions  by  the  preliminary  use  of 
heat,  as  suggested  by  Kellogg,  a  hot  fomentation  to  the  spine  or  by 
hot-water  drinking.  Alcohol  is  a  toxic  drug,  and  its  introduction  into 
a  system  overloaded  with  toxins  seems  to  me  on  its  face  irrational 
and  illogical.     If  it  has  a  place,  reserve  it  for  the  emergencies. 

While  cold  baths  may  be  used  with  impunity  in  ordinary  cases  of 
fever  in  which  the  general  resistance  of  the  body  is  good,  and  before 
the  vital  forces  have  been  depressed  by  the  long  continuance  of  the 
disease,  this  is  by  no  means  true  in  cases  in  which  hydriatic  treat- 
ment has  been  neglected   during  the  first   week  or  ten  days   of  the 

4  Barker    (of   St.   Louis,   Mo.),  Therapeutic  Gazette,   1894. 


IXFECTWUS  DISEASES— FEVERS.  207 

malady.  To  plunge  such  a  patient  into  a  bath  at  65°  to  70°  F.  and 
retain  him  there  for  ten  or  fifteen  minutes  will  most  certainly  imperil 
his  life.  By  means  of  partial  cold  rubbings  applied  to  different 
portions  of  the  body  successively,  the  cutaneous  circulation  may  be 
marvelously  improved  without  increasing,  even  momentarily,  internal 
congestion.  In  the  management  of  these  grave  cases,  in  which  the 
life  of  the  patient  depends  so  much  upon  the  exact  and  judicious 
employment  of  effective  therapeutic  procedures,  it  is  important  to 
remember  that  death  in  these  cases,  when  attributed  to  so-called 
"heart  failure,"  is  really  due  to  general  collapse  of  the  vital  powers. 
The  weak  condition  of  the  heart  is  a  true  index  to  the  condition  of 
the  body  as  a  whole. 

Under  ordinary  circumstances  the  presence  of  perspiration  is 
evidence  either  that  the  febrile  action  is  subsiding  or  that  nature  is 
doing  all  that  can  be  done  to  lower  the  temperature  and  eliminate 
the  toxin  which  is  the  disturbing  element,  and  when  this  is  the  case 
the  patient  should  be  wiped  dry  before  hydriatic  measures  are  made 
use  of. 

The  presence  of  a  dicrotic  pulse  and  marked  weakening  of  the 
first  sound  are  indications  of  an  asthenic  state  of  the  heart,  in  which 
it  is  wholly  unprepared  to  meet  the  tremendous  demands  temporarily 
made  upon  it  by  placing  the  patient  suddenly  in  cold  water.  In 
cyanosis  the  cold  bath  of  Brand  is  decidedly  contraindicated.  This 
symptom  is  an  indication  that  the  movement  of  the  blood  is  slowed 
as  the  result  of  cardiac  weakness,  and  the  heart  is  not  prepared  to 
sustain  the  shock  of  sudden  and  prolonged  contact  of  cold  water 
with  the  whole  surface  of  the  body,  while  the  internal  viscera,  already 
profoundly  congested  in  consequence  of  the  cardiac  inefficiency,  would 
be  endangered,  especially  the  lungs,  liver  and  spleen. 

The  management  of  some  of  the  more  important  symptoms,  aside 
from  the  general  treatment,  is  an  important  element,  giving  the 
patient  comfort  and  satisfaction.  It  must  be  again  reiterated  that 
all  symptoms  are  mitigated  and  often  absent  where  the  full  method 
is  used  from  the  start. 

Headache. — Wet  the  hair  thoroughly  with  water  at  a  temperature 
of  40°  F.  and  apply  a  cold  compress  or  turban  at  40°  to  60°  F., 
renewing  same  as  it  becomes  warm.  If  very  severe,  apply  sinapism 
to  back  of  neck  and  use  ice-cap  or  Leiter  coil  over  compress.  Keep 
room  dark  and  urge  patient  to  drink  freely  of  water.  Avoid  use 
of  morphine. 

Insomnia  and  Delirium. — These  are  best  met  by  use  of  the  half  pack 
over  abdomen  and  upper  hips  at  60°  to  65°  F.,  with  cold  compress  to 
head.     Occasional  doses  of  bromides  may  prove  useful. 

Diarrhea. — The  cold  compress  on  abdomen  will  do  much  to  pre- 
vent this  condition,  though  three  or  four  evacuations  daily  are  not  too 


208  PRACTICAL  HYDROTHERAPY. 

many.  If  actions  are  foul  or  fetid,  use  a  high  enema  of  sterile  water 
at  95°  F.  By  this  means  the  bowel  is  emptied  and  toxins  removed. 
Avoid  the  use  of  medicines  if  possible.  In  like  manner  constipation 
is  best  treated.  An  oil  enema  is  sometimes  better  where  the  feces 
are. hard. 

Tympanites. — Use  first  a  high  enema  of  sterile  water  or  saline 
solution  to  empty  the  bowel  of  all  fermenting  material,  undigested 
food  and  toxins.  Oftentimes  much  gas  will  be  passed  through  the 
colon  tube.  Exercise  great  gentleness  and  care  in  introducing  the 
tube.  Look  more  carefully  to  the  regulation  of  diet.  Then  apply  a 
very  hot  fomentation  for  three  minutes,  repeat  again  and  replace  by 
the  cold  compress.  Repeat  fomentation  and  compress  every  twenty 
to  thirty  minutes  as  needed. 

Hemorrhage. — Administer  morphine,  J/\  grain  hypodermically,  at 
once,  and  keep  patient  perfectly  quiet.  Give  no  food  at  all.  Apply 
ice-bag  over  right  iliac  region  or  ice-cold  compress  to  abdomen.  Ice 
internally  with  freedom ;  also  fluid  extract  of  ergot  every  three  hours. 
If  less  severe,  saline  solution  by  hypodermoclysis  and  lower  head  of 
bed.  In  any  event,  call  in  a  surgeon  in  consultation.  The  mortality 
of  intestinal  hemorrhage  under  the  bath  treatment  is  6  per  cent,  as 
against  5.6  per  cent,  without  the  bath. 

Cardiac  Collapse. — Immediately  place  an  ice-bag  over  the  heart, 
keeping  same  in  position  for  twenty  minutes.  If  this  is  not  sufficient, 
hot  fomentations  over  heart  for  one-half  to  one  minute,  followed  by 
ice-bag.  and  strychnia  or  sparteine  hypodermically.  If  baths  are  being 
used,  raise  the  temperature;  if  they  have  not  been  used,  follow  out 
suggestion  for  late  and  neglected  cases.  Stop  baths  for  a  short  time. 
This  condition  rarely  happens  under  strict  methods. 

Convalescence  should  be  guarded,  and  as  the  patient  regains 
strength  the  baths  are  discontinued  and  tonic  hydrotherapy  gradually 
increased.  By  this  means  nutrition  and  assimilation  are  improved 
and  recovery  quickened. 

La  Grippe — Influenza. 

La  grippe  is  now  practically  co-extensive  with  civilization.  Within 
the  last  decade  and  a  half  influenza  has  penetrated  to  the  smallest 
village  and  hamlet,  its  spread  having  been  extremely  rapid.  I  know 
of  no  infectio-contagious  disease  capable  of  producing  such  wide- 
spread havoc,  such  manifold  and  remarkably  morbid  pictures. 

The  bacillus  of  influenza,  or  Pfeiffer's  bacillus,  possesses  inter- 
esting features,  and  produces  toxemia,  bacteriemia,  and  inflammation 
(purulent).  The  influenza  bacteria  entering  with  the  air  into  the 
respiratory  organs  settle  upon  the  mucous  membrane  of  the  nose, 
throat  and  bronchial  tubes,  where  they  proceed  to  develop  in  enormous 


1XFECTI0US  DISEASES— FEVERS.  209 

numbers  and  excrete  those  poisonous  products  which  arir^e  during  their 
life  activity.  When  they  do  not  penetrate  the  mucous  membrane  the 
symptoms  produced  are  those  of  a  pure  toxemia — that  is  to  say,  the 
poison  is  absorbed  and  circulating  through  the  system  produces  distant 
effects  ;  or  the  bacillus  may  penetrate,  enter  the  circulation  and  cause 
a  true  bacteriemia.  The  bacteria  that  have  entered  the  circulation 
may  settle  in  some  organ  or  tissue,  causing  inflammation,  followed 
by  the  formation  of  pus. 

The  sputum  is  characteristic,  of  a  greenish-yellow  color,  is 
tenacious,  thick  and  adhesive,  coming  from  the  nose,  throat  and 
upper  air-passages.  In  the  sputum  we  find  bacilli  in  large  number> — 
in  fact,  nearly  a  pure  culture,  showing  as  fine  filaments,  being  the 
smallest  bacillus  cultivated. 

Of  all  the  symptoms  attributable  to  la  grippe,  we  may  safely  say 
that  those  pertaining  to  the  nervous  system  are  predominant,  and 
that  this  disease  produces  more  organic  and  functional  nervous  trouble 
than  any  other  acute  infection.  A  careful  study  of  the  forms  of 
grippe  will  show  that  the  picture  is  never  complete  without  a  large 
number  of  nervous  symptoms.  Two  conditions  stand  out  prominently, 
owing  to  their  frequency  as  sequelae  of  the  attack,  these  two  being 
adynamia  or  general  debility,  and  neurasthenia.  Nearly  every  case 
suffering  from  grippe  experiences  in  some  degree  the  debilitating  in- 
fluence of  its  poison,  this  being  shown  in  the  slowness  of  recovery 
and  the  general  sense  of  prostration  and  incapacity  that  follows  the 
attack.  I  draw  the  distinction  between  these  cases  and  those  pre- 
senting the  symptoms  of  true  nervous  exhaustion  or  neurasthenia; 
the  former  might  be  more  properly  called  neurasthenoid.  Neuras- 
thenia following  the  grippe  not  only  possesses  the  general  run  of 
symptoms  in  this  affection,  but  in  my  experience  has  shown  a  peculiar 
tendency  toward  that  of  a  depressed  type — in  fact,  has  at  times 
bordered  closely  on  to  a  psychosis,  melancholy  in  character.  These 
patients  are  apt  to  be  morbid,  and  have  a  fear  of  the  development  of 
further  serious  disease. 

From  what  has  gone  before  it  is  easy  to  see  the  many  dangers  of 
this  disease ;  cases  of  grippe  require  careful  and  considerate  hand- 
ling. The  ordinary  hygiene  of  the  sick-room  must  prevail,  and  in 
addition  the  cuspidors  should  be  filled  with  water  in  which  carbolic 
acid  or  chloride  of  lime  has  been  placed.  Prevention  is  oftentimes 
worth  more  than  a  pound  of  cure,  and  for  that  reason  members  of 
the  family  and  friends  should  not  be  allowed  to  kiss  the  patient,  no 
matter  how  much  their  love  and  affection  may  lead  them  to  osculate. 

The  patient  should  be  always  provided  with  an  alkaline  antiseptic 
spray,  with  instructions  to  wash  out  the  nose  and  throat  every  two  or 
three  hours ;  thus  the  first  element  in  the  treatment  is  met  by  keeping 
the  upper  air-passages  moist  and  open,  the  antiseptic  destroying  the 


210  PRACTICAL  HYDROTHERAPY. 

bacillus  or  preventing  its  further  development.  The  diet  must  be 
liquid,  and  to  those  who  are  strong  but  little  should  be  administered. 
In  elderly  people  and  in  those  who  are  weak  and  delicate  it  must  be 
administered  every  three  or  four  hours.  I  have  a  very  distinct  and 
clear  idea  concerning  the  administration  of  whisky  in  conditions  of 
the  grippe.  I  never  use  it  save  in  cases  of  heart  failure  in  elderly 
people,  and  believe  that  it  does  more  harm  than  good,  as  the  action 
of  alcohol  is  toxic  in  character  and  our  aim  and  object  is  to  eliminate 
poisons  and  not  add  them  to  the  already  overburdened  system. 

In  the  treatment  of  the  acute  condition  endeavor  should  be  made 
to  combat  all  tendency  toward  congestion  and  inflammation,  especially 
that  of  the  pulmonary  and  cerebral  systems.  Every  effort  should  be 
made  to  reduce  functional  activity  and  drain  the  blood  from  them  to 
the  cutaneous  circulation,  this  being  best  secured  by  maintaining 
warmth  and  activity  of  the  skin  surface.  We  can  favor  sweating 
by  first  administering  a  hot  full  dry  pack  for  half  an  hour,  followed 
by  the  cold  sponge  rapidly  performed.  This  may  be  repeated  as 
often  as  every  three  hours,  and  as  the  patient  progresses  the  time  be- 
tween should  be  lengthened.  In  sanatoria  it  is  much  more  satisfactory 
to  admininster  the  electric  light  bath  in  bed  until  perspiration  takes 
place,  followed  by  rapid  cold  sponging.  Superheated  dry  hot  air, 
body  apparatus,  used  promptly  in  the  beginning,  at  250°  to  300°  F., 
for  twenty  to  forty  minutes,  followed  by  cold  sponge  (65°  F.)  or 
horizontal  rain  or  circular  bath  at  75°  F.  for  one-fourth  minute,  often 
cuts  short  the  disease.  When  this  cannot  be  utilized,  the  hot  full  bath 
at  102°  to  104°  F.  for  ten  minutes,  followed  by  a  hot  full  dry  pack, 
will  be  found  serviceable.  This  may  be  administered  once  or  twice 
daily  during  the  acute  stage.  It  may  be  followed  by  the  cold  sponge, 
rapidly  performed.  Another  method  of  stimulating  the  vital  resist- 
ance is  the  use  of  the  full  wet  pack,  commencing  at  a  temperature  of 
90°  F.,  for  thirty  minutes,  repeating  every  four  hours.  Reduce  the 
temperature  five  degrees  and  increase  the  duration  ten  minutes  until 
one  hour  is  reached.  Care  must  be  taken  in  the  administration  of 
all  of  these  methods  to  avoid  general  chilling  of  the  cutaneous  surface. 

With  the  subsidence  of  the  acute  manifestations  of  the  disease 
our  aim  should  be  to  maintain  the  general  vitality  by  all  known  meth- 
ods. As  soon  as  possible  place  the  patient  upon  general  measures. 
Commence  with  the  daily  use  of  the  electric  light  bath,  or  hot-air 
bath,  until  perspiration  takes  place,  followed  by  the  dripping  sheet 
for  three  minutes  at  70°  F.  with  vigorous  friction ;  reduce  two  degrees 
with  each  application  until  60°  is  reached.  As  soon  as  the  reaction 
of  the  patient  has  been  fully  developed  we  may  proceed  to  the  use 
of  the  electric  light  bath,  full  strength,  until  free  perspiration  ensues. 
Follow  this  by  the  horizontal  or  circular  rain  bath  at  104°  F.  for  one 
and   one-half   minutes,   reduced   to   70°    for   half   a   minute,   pressure 


INFECTIOUS  DISEASES— FEVERS.  211 

twenty  pounds.  Reduce  temperature  one  degree  daily  until  60°  F. 
is  reached,  and  increase  pressure  two  pounds  daily  until  thirty  pounds 
is  registered.  As  soon  as  the  patient  begins  to  respond  we  may  ad- 
minister the  following:  Electric  light  bath  until  free  perspiration 
takes  place,  followed  by  the  horizontal  or  circular  rain  bath  for  one 
and  a  half  minutes  at  100°  to  104°  F.,  twenty  pounds,  followed  by 
the  fan  douche  for  one-half  minute  to  the  entire  body,  jet  douche 
to  the  spine  and  lower  limbs  for  one-fourth  minute,  commencing  at 
a  temperature  of  70°,  reducing  two  degrees  at  each  treatment  until 
60°  is  reached,  and  increasing  the  pressure  two  pounds  until  thirty 
pounds  is  registered.  Should  we  have  to  deal  with  any  of  the  in- 
flammatory or  other  troubles  of  the  intestines,  that  are  liable  to  follow 
in  the  wake  of  this  most  pernicious  disease,  we  may  apply  the  Scot- 
tish fan  douche  to  the  abdominal  wall,  in  conjunction  with  other 
general  hydrotherapeutic  treatment.  Where  bronchitis  or  pleurisy 
develop  these  should  be  met  according  to  the  principles  laid  down 
under  the  treatment  of  these  conditions,  whether  they  are  caused  by 
the  grippe  or  not. 

Malarial  Fever;  Intermittent;  Remittent;  Cachexia. 

This  is  an  infectious  fever,  intermittent  or  remittent  in  type,  char- 
acterized by  the  presence  of  chills,  fever,  anemia,  and  enlargement 
of  the  spleen.  The  exciting  cause  is  the  Plasmodium  malariae  of  Lav- 
eran,  which  gains  access  to  the  human  body  through  the  bites  of 
mosquitoes  of  the  genus  anopheles.  These  mosquitoes  breed  in  dis- 
tricts that  are  marshy,  their  greatest  activity  being  a  period  when  the 
temperature  is  high,  humidity  present,  and  an  absence  of  high  winds. 
The  mosquito  is  most  predatory  at  night,  a  fact  recognized  in  those 
districts.  The  various  forms  of  chill  and  fever  are  well  known,  and 
occur  at  varying  periods,  dependent  upon  the  development  of  sporu- 
lation  of  the  parasite.  As  the  spores  are  discharged  into  the  blood- 
stream the  chill  takes  place.  Flagellated  organisms  are  sometimes 
observed.  The  diagnosis  of  malaria  should  be  made  by  the  use  of 
the  microscope,  though  dependence  is  not  to  be  placed  upon  the 
stained  specimen,  for  in  them  the  plasmodium  is  often  absent,  is  in- 
fluenced by  quinine  and  the  time  the  blood  is  taken.  For  a  number 
of  years  I  have  depended  upon  the  examination  of  the  fresh  blood 
and  the  presence  of  pigmented  white  corpuscles  for  a  diagnosis,  and 
believe  it  to  be  an  index  more  constant  than  any  other  I  have  used. 
The  technique  is  simple,  requiring  but  little  time  and  trouble.  Pat- 
rick Manson  says  that  a  pigmented  white  cell  can  only  mean  (  with 
two  rare  exceptions)  malaria,  and  that  if  there  be  malaria  present 
there  will  always  be  pigmentation.  There  is  disintegration  of  the 
blood  cells  in  the  acute  and  enlargement  of  the  spleen  in  the  chronic 
forms.     Preventive  measures  lie  largely  in  the  hands  of  local  health 


212  PRACTICAL  HYDROTHERAPY. 

officers,  and  should  be  directed  to  the  draining  of  marshes  and  ponds, 
or,  where  this  is  impossible,  the  covering  of  such  marshes  and  ponds 
with  crude  petroleum.  In  districts  where  malaria  abounds  the  drink- 
ing-water must  be  filtered  and  boiled,  the  residents  should  avoid  sleep- 
ing near  the  ground,  and  screen  their  houses.  Persons  should  not  sit, 
in  the  evening  during  spring  and  summer,  where  they  can  be  bitten 
by  the  mosquito.  Where  screens  cannot  be  obtained  ordinary  netting 
is  useful.  Recent  Italian  investigations  have  shown  that  five  to  ten 
grains  of  quinine  daily  is  a  protective  of  great  value.  "Quinine," 
say  Marchiafava  and  Bignani,5  "acts  upon  the  malarial  parasites  in 
that  phase  of  their  life  in  which  they  are  nourished  and  developed, 
when  nutritive  activities  cease  by  an  arrest  of  the  transformation  of 
hemoglobin  into  pigment;  when  the  reproductive  stage  begins,  then 
quinine  is  ineffectual  in  action."  For  this  reason,  in  these  cases  the 
quinia  should  be  administered  three  to  six  hours  before  the  attack, 
for  three  to  four  days,  and  repeated  every  seventh  day  for  a  month 
or  six  weeks. 

Hydrotherapy  is  of  great  value  in  malarial  fevers  owing  to  its 
powerful  reconstructive  effects  upon  the  vital  forces,  its  ability  to 
increase  the  number  and  activity  of  the  white  and  red  corpuscles,  to 
overcome  the  anemia,  to  favor  elimination  and  general  functional 
activity.  The  writer  has  had  such  ample  demonstration  of  these  facts 
as  to  assert  the  above  without  fear  of  contradiction.  The  treatment 
resolves  itself  into  that  of  the  attack  and  the  interparoxysmal  period. 
It  is  an  excellent  rule  to  commence  with  a  calomel  purge,  five  grains, 
with  sodium  bicarbonate.  During  the  chill,  administer  hot  drinks 
(water  or  lemonade),  wrap  the  patient  in  warm  blankets,  put  hot 
water  bags  to  feet  and  sides,  and  use  no  cold  hydriatic  applications. 
The  hot  full  bath  (  102°  to  104°  F.)  for  ten  to  fifteen  minutes,  or  the 
hot  dry  pack,  or  hot  wet  blanket  pack,  may  be  employed.  With  the 
cessation  of  the  chill  and  the  commencement  of  the  hot  stage  the 
temperature  rises,  and  we  may  now  gratify  the  patient  by  allowing 
him  to  drink  freely  of  cold  water.  We  may  now  wait  until  this 
stage  has  lasted  an  hour,  and  if  at  this  time  the  temperature  has  net 
fallen,  and  no  signs  of  sweating  being  present,  use  the  cold  sponge,  50° 
to  60°  F.,  taking  care  to  avoid  chilling  the  patient  by  drying  each  part 
thoroughly.  When  sweating  takes  place,  wipe  with  a  cloth  until  dry, 
and  follow  by  rapid  sponge  with  hot  water,  drying  carefully  there- 
after. In  the  remittent  type  we  may  employ  the  same  general  medi- 
cation and  cold  sponging,  such  as  has  been  suggested  in  typhoid  fever. 
The  great  advantage  of  hydrotherapy  in  malaria  is  during  the  inter- 
paroxysmal period,  during  which  time  we  must  strain  every  nerve 
to  prevent  recurrence  by  the  judicious  administration  of  quinine,  and 

S    Marchiafava    and    Bignam:    "Malaria,"    Twentieth    Century    Practice    of    Medicine,    Vol. 
VII,   p.    175. 


INFECTIOUS  DISEASES— FEl  ERS.  213 

the  use  of  iron  and  arsenic  as  tonics.  Always  insist  on  free  drinking 
of  water.  If  the  patient  is  weak  and  confined  to  bed,  continue  with 
the  use  of  the  cold  sponge,  and  in  addition  administer  the  dripping 
sheet  at  50°  to  60°  F.  for  three  minutes  once  or  twice  daily.  1  f  there 
is  reason  to  fear  another  attack,  give  the  full  dry  pack  for  thirty  to 
forty  minutes  an  hour  before  expected  chill,  together  with  hot-water 
drinking,  or  we  may  use  the  full  hot  bath  (  102°  to  104°  F.)  for  ten 
to  fifteen  minutes.  As  soon  as  the  patient  is  up  and  about,  adopt 
eliminant  and  tonic  measures.  Give  the  electric  light  bath,  full  strength,, 
three  to  five  minutes,  the  vapor  five  to  ten  minutes,  or  superheated 
hot  air  ten  to  fifteen  minutes,  or  dry  full  pack  until  free  sweating 
ensues.  Follow  this  with  dripping  sheet,  50°  F.,  for  three  minutes, 
or  the  horizontal  or  circular  rain  bath  or  the  jet  douche.  The  rain 
bath  may  be  given  at  100°  for  one  minute,  pressure  twenty  pounds. 
reduced  to  50°  for  ten  or  fifteen  seconds,  increasing  pressure  and 
decreasing  temperature  daily.  In  like  manner  the  jet  must  be  grad- 
uated. Where  the  spleen  or  liver  is  enlarged  the  alternate  or  Scottish 
douche  should  be  applied  over  the  region  of  these  viscera  with  tem- 
peratures ranging  from  110°  to  50°  F.,  under  a  pressure  of  fifteen  to 
twenty  pounds,  half  minute  for  the  hot,  five  to  ten  seconds  for  the  cold, 
repeated  two  or  three  times. 

In  the  malarial  cachexia  or  chronic  malarial  poisoning,  a  con- 
dition very  commonly  found,  and  in  which  the  patient  is  anemic,  his 
circulation  poor,  skin,  conjunctiva  and  mucous  membranes  jaundiced, 
his  spleen  enlarged,  weakness  and  emaciation  present,  temperature 
subnormal,  with  occasional  febrile  attacks,  hydrotherapy  is  practically 
a  panacea.  I  have  had  a  most  extensive  experience  with  these  cases, 
and  feel  certain  of  giving  relief  by  hydriatic  measures  alone,  though 
I  generally  administer  iron,  quinine,  arsenic  and  strychnia.  There  is 
no  question  that  water  judiciously  applied  does  the  work,  for  as  a 
rule  the  sufferer  has  already  run  the  gamut  of  well-known  medicinal 
remedies  before  utilizing  hydrotherapy.  It  is  marvelous  sometimes 
to  see  the  change  wrought  by  a  few  weeks'  treatment  used  as  above 
(interparoxysmal  period).  Where  hydriatics  are  used,  smaller  doses 
of  quinine  and  tonics  become  effective,  due  to  the  better  assimilation 
of  the  drugs,  a  fact  frequently  noticeable  in  a  few  days.  In  the  per- 
nicious forms  it  may  also  be  used  with  benefit  upon  the  principles 
laid  down  in  the  management  of  the  ordinary  types. 

Dengue  fever  is  an  acute,  febrile,  epidemic  disease,  characterized 
by  a  remitting  fever,  severe  pains  in  the  joints  and  muscles  and  a 
peculiar  eruption.  Its  cause  is  unknown,  but  seems  to  be  closely 
associated  with  atmospheric  conditions.  Its  treatment  by  hydro- 
therapy is  essentially  that  of  malarial  fever. 


214  PRACTICAL  HYDROTHERAPY. 

Measles. 

Rubeola  is  an  acute  contagious  disease,  characterized  by  fever,  a 
crimson,  mottled,  papular  eruption,  terminating  in  branny  desqua- 
mation and  catarrhal  inflammation  of  the  naso-broncho-pulmonary 
mucous  membrane.  Its  origin  is  an  unknown  micro-organism,  found 
mostly  in  the  respiratory  tract,  having  a  peculiar  affinity  for  children 
and  transmitted  largely  through  the  clothes,  one  attack  usually  pre- 
venting subsequent  ones.  Uncomplicated  cases  recover,  the  most 
serious  danger  being  from  lung  involvement.  -Measles  is  a  simple 
disease,  requiring  isolation,  rest  in  bed  and  protection  from  draughts, 
children  being  especially  sensitive  and  bearing  heat  abstraction  poorly. 
They  may  drink  freely  of  demulcent  drinks,  flaxseed  or  slippery-elm 
tea,  strained  raspberry  water,  orangeade,  all  of  which  are  best  sweet- 
ened with  saccharine.  In  the  milder  forms,  where  the  temperature  is 
not  above  103°  F.,  the  sponge  bath  may  be  used  at  95°  quickly  done, 
avoiding  friction,  or  the  full  warm  bath  at  98°  for  ten  minutes  re- 
peated every  four  or  six  hours.  This  bath  may  be  all  that  is  necessary, 
but  where  there  are  pulmonary  complications  these  will  be  best  met 
by  using  the  full  warm  bath  for  ten  minutes,  followed  by  the  affusion 
(see  scarlet  fever)  at  80°  F.,  reducing  the  latter  to  70°  F.  This  must 
be  brief  and  care  taken  afterward  to  prevent  heat  abstraction.  If  the 
temperature  remains  at  103°  F.,  use  the  abdominal  compress  or  half 
pack  at  70°  F.  between  the  baths.  These  baths  should  improve  cough 
and  induce  sleep.  Where  cerebral  complications  exist  (delirium, 
jactitation,  convulsions)  due  to  toxemia,  use  the  full  hot  bath  (110° 
to  115°  F.)  for  ten  minutes,  followed  by  an  affusion  at  75°  F., 
directed  to  the  neck,  chest  and  spine,  repeating  every  four  to  six 
hours.  Foreign  authorities  consider  cold  baths  the  more  efficient 
measure,  and  believe  that  the  toxemia  is  best  combated  and  pulmonary 
complications  more  favorably  influenced  by  their  use.  The  pharyn- 
geal irritation  is  met  by  the  throat  compress,  steam  inhalations  and 
hot  alkaline  gargles.  Bronchial  complications  are  so  frequently 
present,  and  being  the  one  serious  complication,  demand  attention. 
In  this  condition  use  the  chest  compress  at  80°  every  hour,  or  a  cold 
sponge  to  chest  at  60°  F.,  twice  or  thrice  daily.  If  eruption  is  delayed 
the  hot  bath  is  best. 

German  measles  are  treated  in  the  same  manner.  In  both  diseases 
medicines  are  rarely  needed. 

Chicken  Pox. 

Varicella  is  a  mild  contagious  febrile  affection,  characterized  by  a 
vesicular  eruption,  which  early  dries  up  and  falls  off,  and  moderate 
fever.  Its  origin  is  unknown,  but  is  presumably  microbic.  Its  termin- 
ation is  nearly  always  favorable.     The  use  of  the  neutral  bath  twenty 


INFECTIOUS  DISEASES— FEVERS.  215 

to  thirty  minutes  twice  daily  during  the  eruption  and  tonic  measures 
during  convalescence  are  indicated. 

Whooping-Cough. 

Pertussis  is  an  acute  infectious  disease,  characterized  by  a  con- 
vulsive cough,  associated  with  catarrh  of  the  air-passages.  Its  origin 
is  from  an  unknown  organism  asssociated  with  the  sputum.  At- 
tacks render  one  immune.  Isolation  should  be  practiced,  though  on 
bright  sunshiny  days  the  patient  may  go  out,  care  being  taken  to 
avoid  catching  cold.  The  nose  and  throat  should  be  sprayed  with 
Dobell's  solution  and  inhalations  practiced.  There  is  no  question  but 
what  the  disease  can  be  shortened  and  the  patient  made  more  com- 
fortable by  the  use  of  hydriatic  measures.  The  dripping  sheet, 
commencing  at  90°  and  gradually  reduced  to  65°  F.  for  two  to  three 
minutes  twice  daily,  or  the  cold  sponge  reduced  in  a  similar  manner 
to  60°  F.  will  enhance  the  child's  vital  resistance.  These  measures 
may  be  preceded  by  the  neutral  bath  for  twenty  to  thirty  minutes,  or 
by  a  general  cleansing  bath.  The  child  should  be  urged  to  drink  freely 
of  plain  water,  as  much  as  half  to  three  quarters  of  a  gallon  daily. 
The  water  may  be  flavored  with  orange,  lemon,  strawberry  or  rasp- 
berry juice. 

Intense  cough  may  be  relieved  by  the  use  of  the  chest  compress 
for  twenty  to  thirty  minutes,  repeated  every  four  hours.  If  the 
throat  is  irritated  the  throat  compress  should  be  worn.  During  con- 
valescence tonic  measures  must  be  continued,  utilizing  the  dripping 
sheet  as  before  or  the  electric  light  bath  till  perspiration,  followed  by 
the  horizontal  or  circular  rain  bath  at  100°  to  102°  F.,  for  one  to 
one  and  one-half  minutes,  reduced  to  70°  F.  for  ten  seconds.  Children 
can,  as  a  rule,  be  induced  to  take  this  treatment  nicely.  I  have  suc- 
ceeded with  children  as  young  as  five  years. 

Scarlet  Fever. 

An  acute,  self-limited,  contagio-infectious  disease,  characterized 
by  high  temperatures,  rapid  pulse,  a  diffuse  scarlet  rash  or  eruption, 
terminating  in  desquamation,  inflammation  of  mouth,  throat,  and 
frequently  grave  nervous  phenomena.  Its  origin  is  in  an  undiscov- 
ered micro-organism,  peculiarly  virulent,  long-lived,  and  most  fre- 
quently conveyed  in  the  scaly  particles  that  adhere  to  clothes,  food, 
etc.,  and  entering  by  the  respiratory  organs.  Children  are  peculiarly 
susceptible,  though  an  attack  usually  renders  one  immune.  The 
symptoms  are  too  well  known  to  mention.  It  is  a  disease  so  frequently 
destructive  to  life  as  to  warrant  the  practitioner  in  being  cautious, 
the  mortality  ranging  from  10  to  30  per  cent.  It  is  frequently  fol- 
lowed by  grave  sequelae.       The  toxic  agent  cannot  be  neutralized, 


216  PRACTICAL  HYDROTHERAPY. 

although  antistreptococcic  serum  has  been  used  with  some  benefit. 
The  toxin  must  be  combated  by  those  agents  that  secure  general  vital- 
izing effects,  for  by  increasing  the  vital  margin  the  effects  of  the 
disease  may  be  lessened  and  serious  complications  averted.  The 
disease  being  self-limited,  kidney  and  skin  action  must  be  maintained 
to  remove  the  toxins.  In  grave  cases  the  diffuse  dermatitis  and  sup- 
pressed skin  action  require  constant  attention,  and  this,  together  with 
kidney  action  and  support  of  the  heart,  is  the  tripod  of  essentials  best 
met  by  hydriatic  measures.  Isolate  the  patient,  keep  quiet  in  bed  and 
freely  ventilate  the  room.  Diet  is  liquid,  principally  milk.  Complete 
disinfection  of  all  articles  used.  During  the  prodromes  commence 
with  a  calomel  and  soda  purge  and  the  cold  sponge  at  80°  F.,  reducing 
each  time  three  to  five  degrees  until  60°  F.  is  reached.  Induce  the 
patient  to  drink  freely  of  plain,  sterilized  or  carbonated  waters,  taking 
half  to  three-fourths  of  a  gallon  in  the  twenty-four  hours.  Keep 
mouth,  nose  and  throat  antiseptic  by  means  of  hydrogen  peroxide, 
alkaline  or  boric  acid  washes. 

"In  the  prodromal  stage  of  scarlatina,  ere  a  diagnosis  can  be 
clearly  established,  and  in  those  cases  in  which  the  eruption  is  im- 
perfect, with  or  without  high  temperature,  the  chief  brunt  of  the 
disease  is  borne  by  the  heart,  as  evidenced  by  feeble,  rapid,  and 
compressible  pulse,  mottled  or  cyanotic  skin,  and  apathy.  Here  cold 
affusions  afford  most  valuable  resource.  A  full  bath  of  100°  F.,  if 
the  body  temperature  is  not  above  this  point,  or  of  90°  F.  if  above  it, 
will  in  five  or  ten  minutes  allay  the  nervous  manifestations,  con- 
vulsions, twitchings,  etc.  When  these  are  accompanied  by  feeble 
heart  action,  the  child  should  be  held  semi-recumbent  by  one  at- 
tendant, while  another  pours  two  or  four  basinfuls  of  water  at  60° 
or  less  over  the  head  and  shoulders.  After  he  is  dried  and  well 
rubbed,  the  patient  is  placed  between  blankets  to  aid  reaction.  The 
affusion  may  be  repeated  hourly  if  necessary,  the  water  being  reduced 
in  temperature  five  degrees  each  time,  and  the  application  being 
made  briefer.  The  change  is  often  marvelous.  The  cutaneous 
congestion  due  to  imperfect  cardiac  propulsion  gives  way  to  a  bright- 
hued  congestion,  which  relieves  the  laboring  heart ;  the  patient  falls 
into  a  refreshing  slumber.  Even  if  the  temperature  rises,  sleep 
should  not  be  interrupted  unless  the  pulse  indicates  heart  failure." 
(Kellogg.) 

After  the  eruption  has  become  fully  established  we  may  use  the 
full  bath  at  95°  F.,  gradually  cooled  to  90°  F.  for  five  minutes,  the 
temperature  being  reduced  one  or  two  degrees  at  each  bath  until 
80°  F.  is  reached.  Where  for  any  reason  this  is  impossible  or 
declined,  we  may  continue  the  use  of  the  cool  sponging  or  substitute 
the  full  hot  bath.  Commence  at  a  neutral  temperature  of  94°  F., 
gradually  add  hotter  and  hotter  water  until  the  little  patient  com- 
plains. This  bath  is,  as  a  rule,  peculiarly  grateful  to  these  cases,  and 
is  rarely  objected  to  by  members  of  the  family,  for  to  them  it  does 
not  seem  "to  drive  the  rash  in." 


INFECTIOUS  DISEASES— FEVERS.  217 

Keep  the  cool  turban  on  the  head  and  sponge  the  face  with  cold 
water  during  the  bath,  thereby  securing  comfort,  refiexly  stimu- 
lating the  heart  and  preventing  syncope.  Its  duration  should  at  the 
start  be  fifteen  minutes  and  gradually  increased  to  half  an  hour. 
Remove  the  child  to  warm  woolen  blankets,  in  which  he  is  to  remain 
for  thirty  to  sixty  minutes,  and  induce  to  drink  freely  of  water. 
The  author  has  found  children  to  take  kindly  to  demulcent  drinks 
(slippery  elm,  flaxseed  water)  sweetened  and  then  strained,  or  an 
orangeade  in  which  a  small  amount  of  potassium  citrate  has  been 
dissolved,  not  sufficient  to  mar  the  taste;  if  this  disagrees  sweeten 
with  saccharine.  This  will  promote  free  diuresis,  "lift  the  load''  off 
the  kidney  and  secure  the  toxic  elimination  so  much  to  be  desired. 
Watch  the  urine  for  albumin,  blood  and  casts,  and  when  this  occurs 
take  great  care  in  all  hydriatic  procedures  that  the  patient  does  not 
get  chilled.  It  is  conceded  that  cool  sponging  and  baths  are  best  in 
the  earlier  stages,  and  in  the  later  stages  the  hot,  because  of  their 
action  in  preventing  uremic  complications.  In  the  first  stages  we  find 
the  cold  sponge  and  baths  acting  as  an  invigorant  to  the  nervous 
system,  as  an  antipyretic,  sedative  and  heart  tonic,  and  in  my  opinion 
so  enhancing  the  resistive  power  of  the  organism  as  to  act  as  a  pre- 
ventative of  subsequent  complications.  They  should,  be  repeated 
four  to  six  times  daily  as  a  rule. 

Certain  clinical  conditions  or  complications  need  consideration. 
Heart  failure  (weakness,  endo-  or  pericarditis)  is  best  met  by  means 
of  the  ice-bag  applied  to  the  precordia  for  fifteen  or  twenty  minutes 
every  two  hours.  Where  the  condition  is  serious,  remove  at  end  of 
fifteen  minutes  and  apply  hot  fomentation  for  thirty  seconds  and  re- 
apply the  ice-bag.  By  this  means  the  reflex  effects  of  the  ice  are  en- 
hanced, for  when  the  skin  becomes  chilled  nerve  impulses  are  less- 
ened and  the  benefits  that  are  to  be  derived  from  its  use  lost.  In 
case  of  vomiting,  a  hot  fomentation  for  ten  minutes,  repeated  once, 
followed  by  ice-bag  over  stomach,  will  relieve.  Cold  carbonated  water 
or  small  pieces  of  ice  can  be  taken  internally  at  the  same  time.  Diar- 
rhea is  best  controlled  by  enemata  of  sterile  water  at  80°  F.  after  each 
evacuation.  Convulsions,  tremors,  and  other  nervous  manifestations 
are  to  be  met  by  the  use  of  general  hydriatic  measures,  especially  the 
full  hot  bath,  followed  by  a  cold  coil-cap  applied  to  the  head  over  a 
compress  of  gauze.  Keep  bowels  well  open,  and,  if  necessary,  try 
the  bromides. 

For  the  pharyngitis,  tonsillitis,  etc.,  the  author's  throat  compress 
will  be  found  serviceable,  together  with  the  internal  use  of  pellets  of 
ice.  Steam  inhalations  or  the  use  of  hot  gargles  of  alkaline  water  give 
much  relief. 

For  nephritis,  urinary  suppression,  etc.,  use  copious  water-drinking, 
the  hot  full  bath  followed  by  blanket  pack  for  one  hour.     This  bath 


218  PRACTICAL  HYDROTHERAPY. 

under  these  conditions  should  be  raised  to  110°  to  115°  F.,  duration 
ten  to  fifteen  minutes.     Repeat  every  four  hours. 

For  convalescence  institute  some  tonic  hydrialic  measure — drip- 
ping sheet,  half  bath,  horizontal  rain,  etc.  Precede  their  use  by  the 
electric  light  bath,  and  see  that  full  reaction  is  attained.  General 
roborant  tonics — iron,  quinia,  strychnia,  hypo-  and  glycerophosphates 
— are  indicated. 

Diphtheria. 

Diphtheria  is  an  acute  specific  constitutional  disease,  both  epidemic 
and  contagious,  characterized  by  a  local  exudation,  fever,  great  pros- 
tration of  the  vital  powers,  albuminuria  and  various  paralytic  se- 
quelae. Its  origin  is  a  specific  micro-organism,  the  Klebs-Loeffier 
bacillus,  the  toxin  of  which,  generated  in  the  course  of  its  growth, 
produces  the  symptoms  of  the  disease.  It  grows  luxuriantly  on  the 
secretions  of  the  upper  air-passages,  and  is  breathed  freely  into  the 
atmosphere,  adhering  to  all  objects,  thus  requiring  careful  disinfec- 
tion. The  prognosis  is  always  grave,  the  mortality  running  about  10 
to  12  per  cent.  Moderate  exudate,  low  fever  and  good  constitution 
are  favorable.  The  seriousness  of  the  disease  demands  that  we  shall 
from  the  start  use  every  measure  that  will  prevent  the  formation, 
eliminate  the  toxin  and  conserve  the  energy  and  strength  of  the  pa- 
tient. Remove  all  objects  from  the  room,  place  the  patient  in  bed, 
and  keep  the  room  well  ventilated  at  a  temperature  of  70°  F.,  the  air 
of  which  is  rendered  moist  by  means  of  a  steam  kettle.  The  diet 
liquid,  milk,  broth,  eggs,  albumen-orange  solution,  etc.  Tincture  chlo- 
ride of  iron  is  indicated.  The  nose  and  throat  should  be  swabbed 
with  hydrogen  peroxide,  50  per  cent,  solution,  and  sprayed  with  hot 
Dobell's  solution  frequently.  All  attendants  should  wear  clothes  of 
washable  material.  Carefully  sterilize  utensils,  dejecta,  etc.,  and  cleanse 
the  hands  in  antiseptics  after  each  contact.  To  increase  the  vital 
strength  of  the  patient  and  to  prevent  the  loss  of  valuable  strength, 
commence  with  the  cold  sponge  at  60°  F.,  repeating  this  procedure 
three  or  four  times  daily  if  the  temperature  is  high.  Should  the  tem- 
perature be  subnormal,  give  a  short  full  hot  bath,  or  a  hot  fomenta- 
tion to  the  spine,  followed  by  the  cold  sponge.  The  local  condition 
is  best  met  by  the  use  of  a  hot  fomentation  for  ten  or  fifteen  minutes, 
followed  by  the  cold  throat  compress,  removing  the  compress  fre- 
quently and  repeating  the  fomentation  every  two  hours,  in  connection 
with  steam  inhalation  or  hot-water  gargles  of  phenol.  Copious  water- 
drinking  of  sterilized  or  carbonated  waters.  In  threatened  suffoca- 
tion do  not  try  any  hydriatic  measure.  Intubate  or  perform  trache- 
otomy. Therapeutic  nihilism  and  sole  dependence  on  antitoxin  has 
sacrificed  lives ;  utilize  all  measures. 

Cardiac   collapse   calls    for   hot    fomentation    for   one-half   to   one 


IM'ECTIOUS  DISEASES— FEVERS.  219 

minute  to  the  precordia,  followed  by  the  ice-bag  for  fifteen  minutes, 
constantly  repeated  if  necessary,  or  in  milder  cases  every  hour. 

For  the  nephritis  use  full  hot  baths,  commencing  at  a  temperature 
of  100°  F.  and  rapidly  increasing  to  110°  F.,  or  toleration.  Keep  cool 
compress  or  ice-bag  on  head,  and  sponge  face  with  cold  water  while 
in  tub.  Remove  to  dry  full  pack  for  thirty  to  sixty  minutes.  Should 
neuritis,  due  to  the  toxins,  develop,  it  must  be  treated  as  such.  Hot 
applications  are  valuable  during  the  painful  stage,  though  this  is  rather 
difficult  to  use  in  palatal  trouble;  inhalations  and  hot  throat  compress; 
rest  of  the  part  until  inflammation  has  subsided.  The  resulting  paral- 
ysis must  be  treated  by  local  electric  light  baths,  followed  by  cold 
applications ;  the  galvanic  current  to  stimulate  muscular  contractions, 
massage,  gymnastics,  and  later  the  sinusoidal  current 

Convalescence  requires  great  care  and  watchfulness,  rest  in  bed, 
gradual  resumption  of  sitting  and  later  standing  posture.  Continue  the 
cold  sponging  and  the  use  of  the  ice-bag  to  the  precordia,  admininster- 
ing  iron,  quinine  and  strychnia  internally.  Feeding  is  essential  to  com- 
bat the  adynamia  and  anemia.  Later  we  commence  the  use  of  the  drip- 
ping sheet  at  65°  F.  for  three  minutes,  with  good  friction  night  and 
morning;  then  general  roborant  and  reconstructive  measures,  such  as 
electric  light  bath,  until  sweating,  followed  by  the  dripping  sheet  as 
above;  next  the  half  bath  at  65°  F.  for  two  to  five  minutes,  then  the 
horizontal  rain  bath  at  100°  F.  for  one  minute,  followed  by  the  same 
at  65°  F.  for  fifteen  seconds,  pressure  twenty  pounds. 

Mumps. 

Parotitis  is  an  acute  infectious  disease  characterized  by  swelling  of 
one  or  both  of  the  parotid  glands  and  other  salivary  glands,  attended 
with  fever,  pain,  swelling  and  disorder  of  the  function  of  the  glands. 
There  is  a  strong  tendency  to  metastasis  to  the  testes  and  ovaries. 
Atrophy  rarely  follows.  Its  origin  is  a  specific  poison,  probably  mi- 
crobic,  is  epidemic,  males  suffering  mostly.  Prognosis  is  favorable. 
In  simple  cases  the  ordinary  hygienic  rules  and  measures,  isolation 
and  liquid  diet,  are  all  the  measures  that  are  needed.  Rest  must 
be  insisted  on  as  a  preventive  of  orchitis  and  oophoritis.  Cold  water 
drinking  and  the  use  of  the  cold  sponge  at  65°  to  50°  F.,  two  or  three 
times  daily,  will  give  much  comfort  and  reduce  the  fever.  Apply 
fomentations  every  two  or  three  hours  to  the  affected  glands  for  ten 
minutes,  remove  and  place  over  them  the  cold  compress  at  50°  to  60° 
F.,  repeating  this  latter  every  twenty  minutes,  if  necessary,  or  place 
an  ice-bag  over  the  compress.  Keep  this  treatment  up  until  active 
inflammation  subsides.  In  case  of  orchitis,  ovaritis  or  inflammation 
of  the  mammae,  do  not  interfere  too  actively,  but  apply  same  treat- 
ment as  to  parotid  gland,  being  careful  in  the  male  to  embrace  entire 
genital  organs,  as  well  as  inner  thighs ;    in  the  female  make  applica- 


220  PRACTICAL  HYDROTHERAPY. 

tions  to  the  ovarian  region  or  breasts.  A  very  hot  foot-bath  (110°  to 
120°  F.)  ib  of  value  as  a  derivative.  If  pain  in  testicle  is  excruciating, 
a  cold  solution  of  lead  and  opium  wash  may  be  used  on  compress. 
Where  males  are  well  grown  a  suspensory  is  at  times  advisable. 

Convalescence  is  aided  by  tonic  hydriatic  methods  enumerated 
under  other  heads. 

Erysipelas. 

Erysipelas  is  an  acute  specific,  infectious  disease,  characterized  by 
a  peculiar  inflammation  of  the  skin,  generally  of  the  neck  and  face, 
with  febrile  reaction.  It  affects  the  lymphatic  vessels  and  glands, 
tends  to  produce  serous  infiltration  and  suppuration  of  the  areolar 
tissue.  Its  origin  is  microbic,  due  to  the  streptococcus  erysipelatus, 
generally  entering  through  some  break  or  abrasion  of  the  skin  or  mu- 
cous membranes  of  the  nose.  It  is  essentially  a  septic  inflammation. 
The  general  indications  of  isolation  and  sterilization  of  clothes,  etc., 
should  be  observed.  Internally  the  tincture  of  the  chloride  of  iron 
in  large  doses  (10  to  30  drops)  and  quinine  (grs.  1  to  3)  every  three 
hours,  should  be  administered.  Its  extension  is  sometimes  stopped 
by  using  tincture  of  iodine  or  solid  stick  nitrate  of  silver  to  the  periph- 
ery of  the  inflammation.  Antistreptococcus  serum  has  yielded  good 
results.  Hydriatic  measures  resolve  themselves  into  the  use  of  those 
general  roborant  cold  measures  that  will  increase  the  margin  of  vital- 
ity, this  being  especially  true  in  those  who  have  been  otherwise  septic 
(puerperal)  and  in  alcoholics.  We  may  use  the  full  cold  bath  or  full 
cold  pack,  commencing  at  80°  F.  and  gradually  reducing  each  pack 
until  65°  F.  is  reached.     Duration  fifteen  to  thirty  minutes. 

The  best  measure,  in  the  writer's  opinion,  is  the  cold  sponge 
applied  at  60°  F.  every  three  hours,  which  will  be  found  strengthen- 
ing, refreshing,  invigorating  and  temperature-reducing.  Local  meas- 
ures are  of  great  value.  During  the  early  stages  of  the  disease  the 
cold  compress  dipped  in  water  at  50°  to  60°  F.,  containing  two 
drachms  of  carbolic  acid  to  the  pint,  should  be  applied  to  the  area 
affected  every  fifteen  to  twenty  minutes.  Hebra  has  used  continuous 
cold  in  these  cases  with  much  benefit.  Ice  compresses  and  ice-bags 
should  be  avoided,  for  fear  of  sloughing  or  gangrene.  When  the  inflam- 
mation subsides  and  extension  has  ceased,  the  time  of  application  may 
be  lengthened,  or  a  fomentation  for  one-half  to  one  minute,  followed 
by  the  cold  compress,  utilized.  In  case  of  vomiting,  pellets  of  ice 
internally,  the  ice-bag  over  the  stomach,  or  the  half  pack  may  be  em- 
ployed. Free  drinking  of  water  at  all  times.  Should  nephritis  de- 
velop, use  the  full  hot  bath,  commencing  at  96°  F.,  gradually  increas- 
ing the  temperature  to  toleration  for  fifteen  to  thirty  minutes,  fol- 
lowed by  the  full  dry  blanket  pack  for  one  hour.  Keep  a  cold  turban 
on  head  and  sponge  face  during  bath  to  secure  comfort  and  prevent 


IXFECTIOUS  DISEASES— FEVERS.  221 

fainting.  At  the  start  its  duration  should  be  fifteen  minutes,  increased 
to  half  an  hour. 

Remove  to  warm  woolen  blankets,  in  which  the  patient  should 
remain  for  thirty  to  sixty  minutes,  and  induce  to  drink  freely  of  de- 
mulcent drinks.  This  bath  produces  free  diuresis,  diaphoresis,  and 
relieves  the  kidney  of  much  work.  If  heart  action  becomes  feeble, 
peri-  or  endocarditis  develop,  apply  the  ice-bag  to  the  precordia  for 
ten  minutes  every  hour  or  two,  as  the  case  demands  Delirium  calls 
for  the  ice-bag  or  cold  compress  to  the  head. 

Convalescence  is  hastened  by  tonic  hydriatic  measures — the  drip- 
ping sheet,  electric  light  bath,  followed  by  the  horizontal  rain  bath, 
jet  douches  or  half  bath,  the  method  of  using  being  in  the  order 
named. 

Cerebro-Spinal  Meningitis. 

Epidemic  cerebro-spinal  meningitis  is  a  malignant  fever,  charac- 
terized by  headache,  vomiting,  painful  contractions  of  the  muscles  of 
the  back  of  the  neck,  delirium,  coma,  and  frequently  an  eruption 
of  purpuric  spots.  Its  origin  is  microbic,  being  due  to  the  Weich- 
selbaum-Jager  diplococcus  intracellularis,  or  to  a  mixed  infection; 
the  pneumococcus  is  believed  to  be  the  cause  in  many  instances.  Bad 
hygiene,  exposure,  and  sleeping  near  the  ground  are  supposed  causes. 
It  is  slightly  contagious,  its  method  of  transmission  being  unknown, 
but  supposed  to  be  through  the  cribriform  plate  of  the  ethmoid  bone. 
The  complications  and  sequelae  are  numerous.  The  mortality  varies 
in  different  epidemics  from  20  to  75  per  cent.  Isolation  is  best, 
though  not  absolutely  necessary.  All  discharges  and  excreta  must  be 
disinfected.  Liquid,  supportive  diet,  milk,  soups,  eggs,  albumen- 
water,  etc.  For  intense  pain,  morphia  hypodermically ;  coal  tars  and 
depressants  must  be  avoided.  In  1894  Aufrecht,  of  Magdeburg,  in- 
troduced hot  baths,  and  this  has  become  a  recognized  method  since 
then.  The  full  hot  bath,  commencing  at  a  temperature  of  95°  to  100° 
F.  and  rapidly  increasing  to  a  temperature  tolerated  by  the  patient, 
for  fifteen  to  thirty  minutes,  followed  by  the  warm  or  hot  full  dry 
pack,  repeated  three  times  daily,  or,  if  necessary,  every  three  hours, 
is  unquestionably  the  best  method.  During  and  between  the  baths 
the  ice-cap,  cold  cephalic  compress  or  cold  coil  must  be  kept  upon 
the  head.  The  use  of  the  long  Chapman's  spinal  ice-bag  oftentimes 
aids. 

The  influence  of  the  bath  is  to  act  as  a  sedative  to  the  nervous 
system,   to   relax   and   prevent  muscular  spasm,   relieve   pain,   hyper- 
esthesia,   restlessness   and   to   prevent   sequelae.      The   skin   should   be 
kept  constantly  warm  between  baths  in  order  to  draw  the  blood  from. 
the  brain  and  spinal  cord. 

Goldscheider  advises  active  movements  while  the  patient  is  sub- 


222  PRACTICAL  HYDROTHERAPY. 

merged  in  a  bath  of  ordinary  temperature.  Cardiac  collapse  may  be 
combated  by  the  ice-bag  to  the  precordia.  Rogansky,6  after  five 
years'  experience  with  Aufrecht's  method  (fifty-one  patients)  in  the 
women's  wards,  giving  the  bath  for  fifteen  to  twenty  minutes  two 
or  three  times  daily,  says  that  the  bath  to  be  efficient  and  curative 
must  be  commenced  before  the  fourth  day,  although  its  influence  for 
good  is  pronounced  even  after  this  long  a  time  has  elapsed.  A  most 
remarkable  result  was  noticed  on  sub-delirious  patients,  one  bath  fre- 
quently clearing  them  up.     He  gives  the  following  interesting  table: 

X umber  Treated.     Deaths. 

First    day    1  0 

Second  day 1  0 

Third  day   2  0 

Fourth    day    . 6  1 

Fifth  day 10  6 

Sixth  day    7  2 

Seventh  to  twelfth  day 15  5 

Sixteenth  to  thirtieth  day 9  3 

In  the  men's  wards,  of  fifty  cases  in  the  same  epidemic,  practi- 
cally control-cases,  and  treated  by  the  "ordinary  and  usual  methods," 
forty  died,  a  death-rate  of  80  per  cent. ;  death-rate  of  all  cases  by 
Aufrecht  method,  33  per  cent.  Varochilsky  reports  two  recoveries 
and  Vallich  five  cures  out  of  seven  cases.  It  will  be  noted,  however, 
that  where  the  bath  method  was  instituted  during  the  first  four  days 
the  death-rate  was  only  io  per  cent.  The  sequelae  are  comparatively  few. 

Of  late  repeated  lumbar  puncture,  with  drainage  of  the  pus,  has 
been  helpful,  and  in  several  cases  seemed  to  save  life,  even  though 
the  diplococcus  was  present.  The  pus  should  be  drawn  off  slowly  to 
prevent  too  rapid  a  fall  of  pressure. 

Convalescence  is  tedious,  and  the  sequelae  must  be  met  as  outlined 
under  other  heads.  As  the  patient  improves,  general  tonic  and  robor- 
ant  hydriatic  measures  must  be  used,  of  which  tbe  dripping  sheet, 
the  full  wet  pack,  the  electric  light  bath,  followed  by  the  half  bath, 
horizontal  rain  and  jet  douche,  are  to  be  mentioned. 

Smallpox. 

Variola  is  an  acute,  epidemic,  contagious  disease,  characterized 
by  fever,  severe  lumbar  pains  and  vomiting,  lasting  for  three  or  four 
days  and  followed  by  an  eruption,  papular,  later  vesicular,  and  finally 
pustular,  the  pustular  changes  being  accompanied  by  secondary  fever 
and  a  tendency  to  the  development  of  grave  complications.  Its  ori- 
gin is  unknown,  probably  microbic,  possessing  a  virulent  vitality 
for  long  periods.  One  attack  renders  immunity.  Tenner's  great  dis- 
covery of  the  protective  value  of  vaccination  has  been  fully  proven, 

6   Rogansky,    M. :    Medizinskaje   Obezrenige,    1904. 


INFECTIOUS  DISEASES— FEVERS.  223 

and  is  only  rejected  by  rabid  sentimentalists,  who  know  not  whereof 
they  speak.  Epoch-making,  it  has  demonstrated  that  the  ounce  of 
prevention  is  better  than  the  pound  of  cure,  for  just  in  proportion  to 
the  efficiency  and  thoroughness  of  vaccination  is  the  rarity  and  mild- 
ness of  variola.  Its  mortality  ranges  from  4  in  the  discrete,  50  in  the 
confluent  to  100  per  cent,  in  the  malignant.  In  unvaccinated  per- 
sons 20  to  60  per  cent.  die.  Smallpox  comes  under  State  control  at 
present,  and  health  boards  remove  cases  at  once  to  "pest-houses," 
disinfecting  the  premises  where  the  case  originated,  a  law  just  alike 
to  the  sick  and  those  who  must  be  protected. 

By  removal  we  secure  complete  isolation,  a  sine  qua  non.  The 
room  should  be  bare  of  furniture  and  kept  scrupulously  clean,  the 
clothes,  bed-clothing,  utensils,  dejecta,  dishes,  and  all  objects  used 
conscientiously  sterilized.  The  patient  is  confined  to  bed  in  a  dark- 
ened room,  which  should  be  well  ventilated  and  kept  at  a  temperature 
of  about  65°  F.  The  diet  should  consist  of  liquids — milk,  whey, 
broths,  eggs,  and  similar  food.  The  white  of  eggs,  to  which  orange 
juice  .has  been  added,  then  strained,  forms  an  excellent  food.  If 
unvaccinated,  this  should  be  performed  at  once,  in  the  attempt  to  mod- 
ify the  attack.  The  nose  and  throat  must  be  regularly  sprayed  with 
Dobell's  solution,  and  the  eyes  irrigated  with  an  alkaline  boric  acid 
solution.  This  should  be  done  prior  to  feeding.  The  general  treat- 
ment should  aim  at  keeping  the  temperature  down  and  favoring  skin 
activity,  this  being  best  accomplished  by  the  full  bath  As  far  back 
as  1862  Hebra,  of  Vienna,  presented  his  "hammock"  continuous  bath 
for  the  treatment  of  variola  and  other  conditions  requiring  prolonged 
immersion.  Of  its  use  Stokes  (1872)  says:  "It  is  clear  that  in  the 
case  of  the  continuous  bath  we  have  all  the  conditions  completely 
filled  as  regards  the  person  of  the  patient."  Where  the  continuous 
bath  cannot  be  employed  we  may  use  the  full  bath  at  neutral  (94° 
to  96°  F.)  or  warm  temperature  (98°  to  100°  F.)  for  an  hour  or 
more  at  a  time,  keeping  the  head  cool  at  the  same  time  by  the  use  of 
the  cold  turban  frequently  changed.  These  baths  will  do  more  to 
prevent  septic  infection  than  any  other  method  known,  being  at  once 
refreshing,  detergent,  temperature-reducing,  cleansing,  antiseptic  and 
pain-relieving.  It  has  been  suggested  to  add  permanganate  of  potash 
to  this  bath  in  weak  solution.  Between  the  baths  the  cold  abdominal 
compress  at  60°  F.,  frequently  changed.  Guinon  says  that  "in  the  in- 
vasion stage,  with  dyspnea,  somnolence  and  a  tempertaure  of  104°  F., 
cold  full  baths  at  64°  to  68°  F.  for  adults  and  70°  to  74°  F.  for  chil- 
dren, should  be  used  systematically,  and  in  sudden  emergencies  cold 
affusion.  These  cold  baths  do  not  check,  but  favor  eruptions  and 
diuresis.  The  tepid  and  warm  baths  decrease  pain  and  are  cleansing." 
Internally,  tincture  of  the  chloride  of  iron  and  quinine  are  the  best 
remedies. 


224  PRACTICAL  HYDROTHERAPY. 

Certain  symptoms  require  consideration.  In  the  case  of  delayed 
eruption  use  hot  full  bath  for  ten  to  fifteen  minutes,  keeping  a 
cold  turban  on  head  and  sponging  the  face  to  prevent  discomfort  and 
syncope,  followed  by  full  dry  pack.  For  laryngitis  pellets  of  ice, 
antiseptic  sprays  and  the  throat  compress.  Try  and  prevent  by  an- 
ticipating it  with  thorough  attention  to  nose  and  throat.  For  nausea 
and  vomiting  use  pellets  of  ice,  ice-bag  over  epigastrium,  the  abdom- 
inal compress,  the  half  pack  or  sinapism  to  nape  of  neck.  Constipa- 
tion and  diarrhea  are  both  best  met  by  enemata  at  95°  F.,  used 
daily  in  the  case  of  constipation,  and  irrigating  the  bowel  after  each 
movement  in  diarrhea.  Starch  and  laudanum  enemata  are  used  by 
some  authorities.  Lumbar  pain  is  most  efficiently  met  by  the  applica- 
tion of  a  hot  fomentation  applied  at  intervals  or  by  means  of  the  hot 
half  pack  for  thirty  minutes  at  110°  to  120°  F.  if  possible.  For 
sleeplessness,  delirium,  and  other  cerebral  complications  the  cold  ce- 
phalic compress,  the  cephalic  coil  or  cap  and  the  ice-bag  best  meet 
the  needs.  Mild  doses  of  the  bromides  may  be  used,  but  one  must 
remember  that  the  stomach  is  very  sensitive  and  irritable.  The  ques- 
tion of  pitting  is  one  about  which  the  relatives  and  friends  become 
much  exercised,  and  the  horrible  disfigurements  that  have  followed 
variola  justify  this  anxiety.  Finsen,  of  Sweden,  suggested  that  if 
we  exclude  the  chemical  or  actinic  rays — blue,  violet,  ultraviolet — 
we  would  avoid  the  active  chemical  agent,  and  by  admitting  red  and 
infra-red  we  would  have  a  caloric  or  heat  ray  and  little  chance  for 
chemical  action.  This  was  further  borne  out  by  the  fact  that  the 
chemical  rays  induce  inflammation  in  the  healthy  skin,  and  for  that 
reason  are  all  the  more  likely  to  possess  the  power  of  acting  injuri- 
ously upon  unhealthy  skin,  and  this  seems  true,  as  the  most  numerous 
and  deepest  scars  are  found  on  the  face  and  hands — that  is  to  say, 
on  parts  most  exposed  to  daylight.  To  overcome  this,  Finsen  sug- 
gested red  window  glass  and  curtains,  but  it  was  not  an  unqualified 
success ;  nevertheless,  it  should  be  tried.  In  addition,  the  parts  should 
be  kept  continually  moist  by  compresses  wet  with  a  solution  of  glycer- 
ine (2  drachms)  in  water  (1  ounce),  the  compress  being  cut  to  fit 
like  a  mask,  made  of  red  cloth  and  covered  with  oil  silk.  The  hands 
may  be  treated  in  the  same  manner.  Depressing  drugs  should  be 
avoided. 

Convalescence  can  be  hastened  by  graduated  tonic  hydrotherapy. 
When  sufficiently  advanced  the  dripping  sheet,  electric  light  bath,  hor- 
izontal rain  or  jet  douche  may  be  used  as  laid  down  in  this  work. 

Yellow  Fever. 
"Yellow    jack"    is    an    acute    infectious    disease,    characterized    by 
high    fever,   yellowness   of   the   surface,   and   black   or   coffee-ground 
vomit.     Its  origin  is  a  micro-organism,  the  bacillus  icteroides  of  San- 


IXFECTIOUS  DISEASES— FEVERS.  225 

erclli.  its  transmission  to  man  being  brought  about  by  the  intermediate 
agency  of  the  mosquito,  stegotnyia  fasciata.  One  attack  confers 
immunity.  The  disease  has  been  practically  controlled  in  America 
bv  the  sanitation  introduced  by  the  medical  corps  of  the  United  States 
army  in  Cuba  during  the  American  occupation  of  that  island.  The 
mortality  is  high,  ranging  from  15  to  85  per  cent.  The  patient  should 
be  placed  in  a  bare  room,  closely  screened,  with  free  ventilation,  and 
the  air  kept  as  near  65°  F.  as  possible.  The  nurse  should  be  an  im- 
mune. Water  should  be  drunk  copiously ;  hot  lemonade  is  also  valu- 
able. The  conditions  arise  from  the  presence  of  the  toxins,  and  every 
effort  must  be  made  to  maintain  warmth  and  favor  elimination.  At 
the  start,  for  differential  diagnosis,  quinine  should  be  administered 
hypodermically.  W.  Nelson7  suggests  the  use  of  fifteen  grains,  with 
two  drachms  of  sodium  and  water,  given  every  three  hours  until  two 
or  three  doses  are  given.  If  malaria,  the  condition  clears  up;  if  not, 
we  have  to  deal  with  yellow  fever.    The  mixture  is  as  follows : 

Quinia  sulphat dr  i. 

Ac.  sulphuric  dil q.  s. 

Sodii   sulph oz.  i. 

Tr.  cardamon  comp , oz.  ss 

Aquae  q.  s.  ad oz.  viii. 

Fiat  solutio.     One  fourth  a  dose. 

Nelson  says : 

"The  rest  of  the  procedure  was  likewise  born  of  experience;  it 
was  as  follows :  The  patient  was  first  prepared  for  the  vapor  bath. 
It  can  be  given  anywhere  and  in  this  wise:  A  chair  with  a  wooden 
seat  is  secured.  The  patient  is  stripped  and  seated  upon  it.  His  feet 
are  placed  in  a  bucket  of  hot  water,  as  hot  as  can  be  borne  without 
burning.  A  spirit  lamp  is  lit  and  placed  under  the  chair.  The  patient 
is  then  covered  with  blankets,  which  are  carefully  tucked  in  to  prevent 
the  escape  of  heat  or  moisture.  Soon  in  cases  so  treated  the  perspira- 
tion would  show  itself,  rolling  down  the  face,  arms  and  body.  The 
patient  was  wholly  enveloped  in  the  blankets,  head  only  outside.  In 
a  few  minutes  the  skin  lost  its  angry  scarlet  hue.  The  pulse  became 
softer  and  the  headache  less.  The  baths  lasted  ten  or  fifteen  min- 
utes. They  never  were  pushed  to  faintness.  General  improvement 
followed,  to  the  great  relief  of  the  patient  and  his  anxious  friends. 
The  patient  next  was  lifted  and  placed  on  a  bed,  there  to  be  enveloped 
in  fresh  blankets.  Frequently  the  perspiration  kept  on  for  one  or  two 
hours.  Later,  when  the  skin  became  again  dry,  the  pulse  hard  and 
the  face  red,  the  vapor  bath  was  repeated  in  all  its  details,  twice  if 
necessary.  Next  in  order,  as  drugs  are  valueless,  I  give  patients  an 
acid  drink,  one  to  be  used  freely,  any  of  the  mineral  acids  largely 
diluted.  It  was  a  grateful  mixture.  I  let  them  take  a  half  tum- 
blerful of  it  hourly  or  half  hourly  if  the  thirst  was  great.  By  this 
simple  treatment  two  great,  and,  to  my  mind,  most  important  indica- 
tions are  met — the  loaded  intestines  are  emptied  and  the  hot  and 
burning  skin  is  forced  to  act  and  eliminate  its  secretions,  the  system 

7  Nelson,  W.:  "Yellow  Fever,"  Twentieth  Century  Practice  of  Medicine. 

xvi 


226  PRACTICAL  HYDROTHERAPY. 

being  relieved  of  the  surcharged  effete  and  fecal  material.  The  thirst 
is  incessant;  water  in  abundance,  or,  better  still,  acidulated  drinks, 
should  be  given.  The  old  practice  withheld  water.  The  vomiting 
continued  just  the  same,  without  it  as  with  it.  It  is  a  most  valuable 
flushing  agent,  to  say  nothing  of  the  relief  afforded  to  the  fever- 
stricken  patient.  Symptoms  have  to  be  dealt  with  one  by  one.  In  my 
experience  a  temperature  of  105°  F.  and  upwards  in  many  cases 
means  delirium,  sometimes  violent  delirium.  In  1880  I  commenced 
using  cold  applications  in  cases  of  high  temperature.  A  tub  was  filled 
with  large  pieces  of  ice,  towels  were  placed  on  them,  and  soon  as 
they  became  wet  through  and  cold  they  are  placed  on  the  patient's 
body,  the  arms,  legs  and  trunk,  to  be  renewed  as  soon  as  they  become 
warm.  They  abstract  heat  rapidly,  and  when  the  temperature  fell  to 
104°  or  104.5°  F.  delirium  and  restlessness  ceased.  Regarding  diet,  the 
patients  do  not  want  or  ask  for  any  form  of  nourishment.  The  idea 
seems  wanting.  While  spirits  and  champagne  have  been  advised,  I 
fail  to  recognize  their  utility.  It  is  needless  to  state  that  the  manage- 
ment of  convalescence  requires  a  special  care  and  constant  vigilance. 
As  soon  as  the  patient  rallies  a  little,  a  ravenous  appetite  develops. 
This  is  a  source  of  great  peril,  and  if  the  patient  or  his  nurse  ignores 
advice  death  will  result.  The  diet  must  be  plain,  beef  or  chicken 
broth,  free  from  fat,  a  little  jelly  or  custard,  a  little  Vichy  or  seltzer 
and  milk.  Plain  water,  Vichy  or  seltzer  to  allay  thirst  as  soon  as  it 
can  be  tolerated,  may  be  freely  given  with  marked  advantage.  When 
admissible  the  juice  of  ripe  oranges  is  grateful.  These  juices  have  an 
excellent  effect  upon  a  torpid  liver.  In  due  time  a  mild  tonic  of  iron 
and  strychnia  is  of  value.  For  weeks  and  weeks  the  patient's  stomach 
will  be  in  a  very  sensitive  state.  In  convalescence  after  severe  cases 
I  personally  do  not  think  that  any  meat  should  be  allowed  for  at 
least  three  weeks  after  the  crisis  has  been  turned.  As  soon  as  the 
patient  is  strong  enough  a  bath  of  tepid  water  with  a  little  carbolic 
acid  may  be  given.  At  the  second  bath  the  nurse  may  wash  the 
patient's  head  and  body  very  carefully  with  soap.  Four  or  five  baths 
of  this  nature  may  be  given  on  as  many  days,  their  frequency  de- 
pending upon  the  patient's  condition.  A  day  or  two  later  the  patient 
may  be  taken  into  a  different  room,  well  away  from  any  draught, 
when  the  room,  clothing  and  the  effects  that  have  been  in  the  room 
can  be  thoroughly  disinfected.  As  far  as  the  mattress  is  concerned, 
it  should  be  sprinkled  with  spirits  of  turpentine  or  coal  tar,  taken 
into  the  open  and  burned.  The  sending  of  the  patient  to  a  northern 
climate  to  complete  convalescence  is  an  excellent  measure.  Away 
from  the  hot  and  enervating  tropics,  they  pull  themselves  together 
more  rapidly.    When  fully  restored  they  can  return,  forever  immune." 

In  addition  to  the  above,  the  cold  sponge  may  be  utilized  at  such 
times  as  the  fever  rises,  or  may  be  regularly  used  every  three  or  four 
hours  to  prevent  too  great  increase  of  temperature.  In  case  of  de- 
lirium and  cerebral  restlessness  we  can  employ  the  cold  cephalic  com- 
press, over  which  is  placed  the  cephalic  coil  cap,  through  which  cold 
water  is  slowly  run.  Gastric  irritation  and  vomiting  are  helped  by 
the  use  of  the  fomentation  for  ten  or  fifteen  minutes  every  two 
hours,   followed  by  the  ice-bag.     Cardiac  collapse  calls   for   free  use 


INFECTIOUS  DISEASES— FEVERS.  117 

of   ice-bag  to  precordia,   alternated   with   a   short  application   of  the 
fomentation. 

Cholera. 

Asiatic  cholera  is  an  acute,  infectious  disease,  occurring  usually 
in  epidemics,  characterized  by  vomiting  and  purging  of  a  peculiar 
rice-water-like  fluid,  severe  muscular  cramps,  prostration,  collapse  and 
death  or  reaction  from  collapse  with  subsequent  development  of  a 
typhoid  state.  The  origin  is  a  micro-organism,  the  comma  bacillus 
of  Koch,  which  is  found  in  enormous  numbers  in  the  discharges. 
Cholera  is  little  contagious  but  infectious.  It  is  usually  conveyed 
by  drinking-water,  due  to  soil  contamination  from  cholera  stools. 
Flies  frequently  act  as  carriers  of  the  contagion.  It  is  claimed  that 
the  bacillus  is  ineffective  in  the  intestinal  canal  unless  persons  are  the 
subject  of  catarrhal  states,  and  it  is  further  known  that  a  healthy 
stomach  will  destroy  the  bacilli.  There  is  no  immunity  conferred 
by  an  attack.  Debility,  ill-health,  intemperance  and  intestinal  catarrh 
are  favorite  grounds  for  their  development.  In  epidemics  fright  in- 
creases the  mortality ;  this  fact  has  been  utilized  by  Eugene  Sue  in 
his  book,  the  "Wandering  Jew,"  in  the  character,  "-Monsieur  Robin." 
Prophylaxis  is  the  essential  in  those  likely  to  be  subjected  to  the 
contaminating  influence  of  the  bacillus,  and  to  this  end  persons  should 
be  careful  to  avoid  infection.  This  is  accomplished  by  the  use  of 
none  but  sterilized,  boiled  water  or  milk  and  the  eating  of  light, 
easily  digested  food.  All  food  should  be  protected  from  contact 
with  insects.  All  alcoholic  or  malt  beverages,  much  meat  and  unripe 
fruit  must  be  avoided.  The  Japanese  have  used  immunizing  serum, 
but  it  is  still  imperfect.  Cleanliness  is  a  most  essential  precaution, 
frequent  bathing  with  warm  water  and  soap,  using  a  fleshbrush, 
followed  by  the  cold  shower,  plunge  or  ablution,  is  one  of  the  best 
preventatives.  "With  pure  water,  pure  air,  pure  soil,  and  pure 
habits,  cholera  need  not  be  feared."  (Hart).  Sir  Thomas  Watson 
says  that  people  who  use  cold  water  daily  are  frequently  exempt. 
The  mortality,  as  a  rule,  is  high,  ranging  from  20  to  30  per  cent. 

Treatment  must  be  instituted  early.  Isolate  the  patient  in  bed  and 
carefully  sterilize  all  the  discharges,  bed  linen,  knives,  forks,  dishes, 
etc.  The  nurses  should  be  careful  to  wear  washable  garments,  cover- 
ing their  hair,  shoes,  and  clothes  with  over-coverings  that  can  be 
easily  discarded.  The  hands  and  arms  should  be  cleansed  in  anti- 
septics after  each  contact.  The  discharges  must  be  caught  in  chlor- 
inated lime  solution  and  burned.  Calomel  at  the  start,  and  in  the 
early  or  diarrheal  stage  the  "Sun"  or  other  well-known  mixtures. 
Hydrotherapy  seems  to  offer  the  best  method  of  treatment.  The 
entire  gastro-intestinal  canal  demands  treatment.  To  meet  this  indi- 
cation we  should  have  the  patient  at  once  drink  as  many  glass fuls 


228  PRACTICAL  HYDROTHERAPY. 

of  hot  water  containing  each  three  drops  of  hydrochloric  acid,  as 
much  as  six  or  eight  being  taken.  The  abdomen  should  now  be 
kneaded  in  order  to  expel  the  liquid.  In  addition,  enteroclysis  should 
be  performed,  introducing  the  soft  rubber  tube  far  into  the  colon 
and  irrigating  with  two  or  three  gallons  of  hot  soap  and  water, 
allowing  same  to  pass  out  later  along  the  tube.  It  was  Cantani8  who 
first  suggested  this  method.  As  soon  as  the  canal  is  well  washed 
out  introduce  a  large  quantity  of  normal  saline  to  make  up  for  loss 
of  liquids  by  the  movements.  Hypodermoclysis  should  be  added, 
employing  Cantani's  solution — distilled  water  one  quart ;  chloride  of 
sodium  one  drachm,  carbonate  of  sodium  forty-five  grains ;  warm  to 
100.4°  to  104°  F.  and  inject  one  or  two  quarts  into  the  subcutaneous 
tissue  of  the  flanks.  The  results  of  this  method  are  most  striking, 
sometimes  even  in  the  algid  stage;  if  it  does  not  save  life  it  at  least 
gives  the  patient  some  relief  from  his  suffering.  It  elevates  the  tem- 
perature, increases  heart  action,  favors  secretion  of  urine,  etc.  Dr. 
Elmer  Lee  is  a  champion  of  the  method  of  enteroclysis,  and  says : 

"The  plan,  as  finally  adopted  in  St.  Petersburg,  was  to  take  the 
patient  from  the  ambulance  to  the  bath-room  without  delay,  and 
when  the  clothes  were  removed  the  patient  was  laid  on  his  back  on 
the  irrigating  table,  with  the  knees  drawn  up  and  the  muscles  of  the 
abdomen  relaxed ;  the  long  tube,  after  being  lubricated  with  soap,  was 
gently  pushed  into  the  rectum  and  urged  by  a  twisting,  gentle  pressure 
into  the  lower  bowel,  as  high  as  it  could  be  made  to  go,  and  the 
stream  of  the  previously  prepared  solution  of  warm  water  and  soap, 
making  a  soapsuds,  was  allowed  to  run  into  the  colon.  When  the 
colon  became  filled  the  pressure  exerted  would  force  the  water  to 
seek  an  outlet  back  through  the  bowel  and  out  of  the  opening  around 
the  outer  surface  of  tube  into  a  properly  constructed  receiving-vessel. 

"After  the  bowels  had  been  cleansed  the  patient  was  placed  in 
a  bath  of  warm  water  and  afterward  conducted  to  his  bed.  The 
irrigation  was  repeated  one  or  more  times.  The  average  number  of 
times  that  irrigations  were  given  in  St.  Petersburg  was  twice ;  occa- 
sionally a  third  irrigation  was  given,  but  frequently  one  irrigation 
was  found  sufficient.  There  would  occur  one,  three  or  four  evacu- 
ations, which  would  be  followed  by  an  interval  of  rest  and  cessation 
of  from  twelve  to  twenty-four  or  thirty-six  hours.  Relief  of  the 
spasm  of  the  intestinal  muscles,  which  produced  the  intense  suffer- 
ing, followed  promptly  upon  the  removal  of  the  irritating  contents, 
and  the  administration  of  morphine  was  not  required.  In  nearly 
every  case  the  stomach  was  also  irrigated  with  a  solution  of  salt  and 
water.  After  this  combined  treatment  vomiting  and  purging  in  most 
cases  would  subside.  As  an  internal  treatment  I  recommended  and 
used  hydrogen  dioxide  diluted  with  distilled  water,  given  in  cupful 
doses  at  intervals  of  three  hours,  with  the  object  of  further  cleansing 
and  disinfecting  the  intestinal  canal. 

"The  irrigating-apparatus  consists  of  a  low  table  suitably  made, 
as  represented  in  the  accompanying  illustration.     Such  an  apparatus 

8  Cantani,   B. :   Berliner  klinische  Wochenschrift,   No.   37,   1892. 


INFECTIOUS  DISEASES— FEVERS.  229 

should  be  provided  near  the  homes  of  the  poorer  classes,  as  well  as 
in  every  part  of  the  city,  and  a  physician  should  be  detailed  to 
receive  and  treat  every  person  with  symptoms  of  looseness  of  the 
bowels  or  abdominal  colic.  Then,  if  thought  desirable,  the  patient 
should  be  transferred  to  a  hospital  or  permitted  to  return  home." 

The  generally  accepted  method  of  external  hydriatic  treatment  is 
that  of  William  Winternitz  and  employed  in  German  hospitals.  The 
patient  was  enveloped  standing  in  a  cold  dripping  sheet  and  rubbed 
down  until  the  surface  of  the  body  became  warm.  After  three  to  five 
minutes'  rubbing  he  was  wrapped  up  in  a  blanket  and  put  into  a  sitz 
bath  at  a  temperature  from  44°  to  59°  F.,  where  he  remained  fifteen 
to  thirty  minutes,  the  abdomen  being  rubbed  energetically  by  the 
attendants,  and  his  extremities  and  such  parts  of  his  body  not  in  the 
water  protected  by  flannels.  He  was  now  put  to  bed  with  a  compress 
wrung  out  of  water  at  a  temperature  of  50°  F.  applied  to  the  abdomen. 
By  this  time  the  patient  began  to  perspire  and  feel  comfortable.  If 
diarrhea  appeared  within  four  to  six  hours  the  same  treatment  was 
repeated,  which  was  rarely  needed.  When  objections  were  abundant 
the  application  was  limited  to  rubbing  with  the  cold  dripping  sheet 
well  wet  and  the  use  of  abdominal  compresses,  with  an  early  resort  to 
subcutaneous  saline  infusions.  Inject  a  syringeful  every  minute  till 
the  pulse  returns,  then  once  in  five  minutes,  and  later  once  every 
half-hour.  And  not  till  the  urine  is  secreted  in  considerable  quantity 
should  this  procedure  be  stopped. 

"Clinical  as  well  as  post-mortem  observations  have  taught  us  that 
the  shock  in  the  pre-algid  stage  is  due  to  the  rapidity  of  transudation 
rather  than  its  quantity.  Whatever  may  be  its  cause,  the  object  of 
our  treatment  must  be  to  strengthen  the  action  of  the  heart  and 
accelerate  the  circulation  of  the  blood,  which  has  become  stagnant. 
For  this  purpose  no  procedure  is  more  effective  than  such  a  thermic 
and  mechanical  irritation  of  the  skin  as  is  produced  by  the  above- 
outlined  treatment ;  and  the  greater  the  collapse  the  more  urgent  the 
indications  for  its  employment."     (Winternitz.) 

When  cramps,  a  most  disagreeable  and  distressing  condition,  arise 
they  can  be  best  met  by  rubbing  the  affected  areas  with  a  smooth 
piece  of  ice,  the  excruciating  pain  being  relieved  rapidly.  Where 
choleraic  anuria  exists  it  is  best  combated  by  the  use  of  hot  drinks  or 
the  hot  full  bath,  hypodermoclysis  and  hot  saline  injections.  In  the 
extreme  algid  stage  the  patient's  entire  body  may  he  rubbed  with 
smooth  pieces  of  ice  until  the  skin  becomes  warm,  after  which  he 
should  be  removed  to  hot  blankets.  Keep  warm  and  repeat  the  pro- 
cedure as  often  as  indicated. 

Cholera  Nostras. 

Cholera  morbus  or  cholera  nostras  so  closely  resembles  Asiatic 
cholera  in  its  clinical  aspects  as  to  deserve  consideration  at  this  point. 


230  PRACTICAL  HYDROTHERAPY. 

There  is  great  difficulty  in  differentiating  the  diseases  ;  many  authors 
believe  they  are  identical.  While  the  micro-orgarnsm  closely  re- 
sembles the  comma  bacillus  of  Koch  morphologically,  it  nevertheless 
liquefies  gelatin  and  does  not  give  the  cholera-red  reaction.  The 
disease  is  considered  to  be  an  acute  catarrhal  inflammation  of  the 
mucous  membrane  of  the  intestinal  tract,  characterized  by  severe 
pains  in  the  abdomen,  incessant  vomiting,  purging,  cold  surface, 
muscular  contractions,  weak  pulse  and  great  prostration.  The  stools 
become  rice-water-like  in  character,  though  in  some  cases  they  remain 
bilious  .and  serous.  The  disease  is  usually  seasonal,  especially  present 
in  summer  and  early  autumn.  The  mortality  is  about  5  per  cent., 
some  cases  lasting  only  one  or  two  days,  some  one  or  two  weeks.  The 
treatment  is  essentially  that  of  Asiatic  cholera.  Prophylactic  meas- 
ures, especially  in  diet  and  hygiene,  are  important. 

Typhus  Fever. 

Spotted  fever  is  an  acute,  infectious,  febrile,  epidemic  disease, 
highly  contagious,  characterized  by  sudden  onset,  intense  depression 
of  the  vital  powers  and  peculiar  maculated  and  petechial  eruption 
and  sickening  odor.  Its  origin  is  supposed  to  be  an  infecting  micro- 
organism, which  at  the  present  time  is  unknown,  and  which  is  in- 
fluenced by  filth.  The  United  States  is  free  from  the  disease,  which 
is  rarely  seen  except  in  its  sea-ports,  among  emigrant  population. 
The  prognosis  is  variable,  the  mortality  running  from  10  to  35  per 
cent.  The  contagious  nature  of  the  disease  renders  it  imperative 
that  the  patient  be  isolated  in  a  room  devoid  of  carpets,  hangings, 
etc. ;  in  fact,  treatment  in  the  open  air  is  the  best.  If  possible  a 
nurse  should  be  secured  that  is  immune.  The  patient  should  be  placed 
in  a  single  bed  accessible  at  either  side  and  the  clothing  and  bed  linen 
frequently  changed,  care  being  taken  to  carefully  sterilize  all  articles. 
The  dejecta  must  be  caught  in  antiseptic  solutions  and  burned,  the 
nurse  at  the  same  time  taking  care  to  protect  herself  by  wearing 
washable  clothing  and  sterilizing  her  hands  and  arms  after  each  con- 
tact. The  mouth  should  be  kept  clean  and  antiseptic,  the  teeth  being 
washed  several  times  daily  with  a  brush.  DobelFs  solution  is  to  be 
frequently  sprayed  into  the  nose  and  throat.  The  hydriatic  manage- 
ment of  this  disease  resembles  in  many  respects  that  of  typhoid  fever, 
with  the  exception  that  the  measures  adopted  should  be  less  refriger- 
ant. To  this  end  the  use  of  the  cold  sponge  is  a  very  valuable 
measure,  as  is  the  full  cold  bath  at  a  temperature  ranging  from  90° 
to  80°  F.  Friction  should  be  maintained  during  this  bath,  and  the 
patient's  head  carefully  protected  by  means  of  the  cold  turban  or  ice- 
cap during  its  application.  The  prolonged  neutral  bath  once  or  twice 
daily  has  been  suggested  in  this  disease.     The  cold  full  pack,  repeated 


IXFECTIOUS  DISEASES— FEVERS.  231 

every  three  hours,  may  be  used  in  place  of  the  full  cold  bath.  This 
bath  has  one  decided  advantage  in  that  it  tends  to  prevent  the  ner- 
vous complications  so  often  present  in  this  disease ;  in  fact,  insomnia, 
cerebral  congestion,  headache  and  delirium  are  best  met  by  the  com- 
bination of  the  prolonged  neutral  bath,  with  application  of  the  cold 
cephalic  compress  with  the  cooling  coil-cap.  Outside  of  the  hydriatic 
measures  and  general  hygienic  management  of  the  case  little  else  need 
be  done.  The  effect  of  the  bath  is  to  promote  the  action  of  the  skin, 
abstract  heat,  stimulate  the  liver  and  destroy  toxins,  incease  diuresis, 
lessen  cellular  disintegration,  favor  antisepsis,  calm  and  tone  the  heart 
and  nervous  system  and  increase  phagocytic  action. 

Montana  Spotted  Fever. 

In  1902  Wilson  and  Chowing  and  later  Ashburn,9  called  atten- 
tion to  this  febrile  disease,  which  had  been  noted  by  local  observers 
in  the  Bitter  Root  Valley,  Montana ;  the  Snake  River  Valley  in  Idaho, 
Quinn  River  in  Nevada  and  certain  parts  of  Wyoming.  These  ob- 
servers found  that  it  was  parasitic  in  origin  and  transmitted  by  in- 
sects. In  its  clinical  aspects  this  fever  partakes  of  certain  features 
of  typhus  fever,  and  at  times  epidemic  cerebro-spinal  meningitis.  It, 
however,  is  not  contagious,  and  the  nerve  symptoms  are  much  lighter 
than  those  of  the  last-named  disease.  It  is  seasonal,  occurring  al- 
most exclusively  in  the  spring  and  early  summer,  following  an  incu- 
bation period  of  three  to  ten  days.  The  onset  may  be  by  chill  or 
chilly  sensation,  headache,  bone  and  muscle  pains  and  nausea,  to 
which  later  may  be  added  nose-bleed  and  slight  bronchitis.  The 
fever  gradually  rises,  with  evening  exacerbations,  and  reaches  its 
maximum  from  the  eighth  to  the  twelfth  day,  when  the  evening  tem- 
perature may  register  105°  or  even  107°  F.  It  remains  high  in  fatal 
cases,  and  in  favorable  ones  falls  by  lysis.  The  eruption  is  charac- 
teristic, appears  in  most  cases  about  the  third  day,  first  on  the  wrists, 
arms  and  legs,  later  on  the  forehead,  back  and  chest,  and  last  on  the 
abdomen.  The  eruption  commences  as  bright  red  macules,  changing 
to  a  purplish  hue,  and  finally  becoming  definite  petechiae.  The  patho- 
logical changes  in  the  internal  organs  are  those  parenchymatous  con- 
ditions usually  found  in  febrile  states. 

Ashburn10  has  found  in  this  disease  that  the  Brand  treatment  of 
typhoid  fever,  together  with  occasional  infusions  of  normal  salt  solu- 
tion, is  the  best  method.  Each  patient  presenting  a  temperature  of 
102.5°  F.  is  placed  in  the  full  bath  at  70°  F.  for  ten  to  twenty  min- 
ntes,  constant  friction  being  applied  to  the  body  and  limbs,  and  simul- 
taneous cold  applications  are  made  to  the  head.  The  bath  should  be 
followed  by  feeding,  quiet,  rest  in  bed,  and,  if  necessary,  hot-water 

9  Journal  American  Medical  Association,   May  27,   1905,  p.   1686 
10  The  Lancet-Clinic,  Vol.  LIV,  No.   17. 


232  PRACTICAL  HYDROTHERAPY. 

bottles  to  the  feet.  Ashburn  calls  attention  to  the  fact  that  all  the 
precautions  required  in  the  administration  of  the  full  bath  in  typhoid 
fever  must  be  follozved  in  treating  these  cases,  especial  care  being 
exercised  to  constantly  use  friction.  He  finds  that  it  is  most  effective 
upon  the  circulation,  and  through  this  channel  secondarily  influences 
the  skin,  kidneys,  lungs,  nervous  system  and  temperature.  The  baths 
should  be  give  at  fairly  regular  internals.  Success  has  resulted  from 
this  treatment. 


CHAPTER  XII. 
DISEASES  OF  THE  STOMACH  AND  INTESTINAL  TRACT. 

Acute  Gastritis. 

Acute  gastritis  is  an  acute  catarrhal  inflammation  of  the  mucous 
membrane  of  the  stomach.     It  originates  most  frequently  from  indi- 
gestible  food,  alcoholic  beverages,   infectious   fevers,  irritating  medi- 
cines and   corrosive  poisons.     The  prognosis   is  variable,   depending 
upon  the  cause;  it  is   frequently   followed  by  the  chronic  form.     In 
its  treatment  the  first  essential  is  rest;  to  secure  this  rest  the  patient 
must  be  put  to  bed  and  all  food  withheld,  if  necessary,   for  several 
days.     Small  pieces  of  cracked  or  shaved  ice  may  be  given.     Unless 
absolutely  necessary,  do  not  administer  morphine.     With  an  improve- 
ment of  the  condition,  we  may  commence  with  clam  broth,  fresh  milk, 
Eskay's  food,  meat  juices,  and  in  a  few  days  light  diet,  gradually  in- 
creased to  the  normal.     Hydrotherapy  is  the  most  satisfactory  of  all 
treatments.     The  best  method  is  that  of  the  hot  fomentation,  applied 
fifteen  to  twenty  minutes  over  the  stomach  and  bowels,  followed  by 
the  abdominal  compress  at  60°  ;  repeat  every  two  or  three  hours ;  this 
will  frequently  give  immediate  relief.     To  this  may  be  added  the  hot 
foot-bath  at  110°  to  115°  F.  for  fifteen  minutes.     Another  method  is 
to  use  the  hot  foot-bath  followed  by  the  hot  half  pack  for  one  hour ; 
it  is  also  an  excelllent  method.     I  have  seen  undoubted  benefit  from 
the  internal  administration  of  hot  water.     Winternitz  has  had  much 
successs  with  the  use  of  the  cold  compress  frequently  repeated.    Where 
the  nausea  does  not  yield  to  this  treatment,  we  mav  apply  the  hot 
fomentation    to   the    epigastrium,    followed    by   the    ice-bag   over   the 
stomach  or  to  the  spine  opposite.     In  two  of  my  cases  magical  relief 
has  been  given  by  careful  lavage  with  very  hot  water.     The  pain  is 
best    relieved   by   the   hot    fomentation    and   compress    frequently    re- 
peated, in  conjunction  with  hot  water  or  lavage.     In  infants  or  young 
children  the  use  of  one-sixth  of  a  grain  of  calomel  placed  upon  the 
tongue  dry,  repeated  until  six  closes  are  given,  will  frequently  aid  in 
recovery. 

Chronic  Gastritis. 

Chronic  gastritis  is  a  chronic  catarrhal  inflammation  of  the  stom- 
ach, with  thickening  of  its  coats  and  some  atrophy  of  the  glandular 
structures.     It  originates   frequently   from  previous  attacks  or   from 
the  use  of  alcoholic   liquors  and   cold  beers.     Unsuitable,   irritating 
(233) 


234  PRACTICAL  HYDROTHERAPY. 

and  improperly  cooked  food,  poorly  masticated  and  insalivated,  to- 
gether with  irregularity  in  meals  and  overeating,  has  been  in  my  ex- 
perience, the  most  frequent  cause.  Many  infectious  diseases,  dis- 
eases of  other  organs,  and  the  overuse  of  tobacco  may  be  noted.  The 
prognosis  is  good  in  those  cases  that  have  not  reached  the  atrophic 
stage ;  even  these  can  be  ameliorated.  Prevention  is  better  than  cure. 
These  cases  should  avoid  fatty,  saccharine,  starchy  and  highly  seasoned 
food,  under  which  head  would  come  mustard,  pepper,  vinegar,  strong 
acids,  preserves,  cheese,  alcoholic  beverages,  tea,  coffee,  coarse  vege- 
tables, pickles  and  confectionery.  The  diet  should  be  plain  and  con- 
sist of  lean  tender  meats,  finely  divided,  beef,  mutton,  sweetbread, 
chicken  and  squab,  calf's  foot  and  pig's  head  jelly,  eggs,  milk  (if 
borne),  purees  of  vegetables,  rice,  cereals  (well  cooked),  spinach, 
celery,  mashed  French  peas,  apples,  boiled,  baked  and  mashed  pota- 
toes, cream,  butter,  toast,  zwieback.  Plain  water,  milk,  and  cereal 
coffees  may  be  used.  All  food  must  be  well  chewed  before  swallow- 
ing. Mental  and  physical  rest,  freedom  from  business  and  work  are 
advantageous.  The  clothing  should  be  such  as  will  protect  the  abdo- 
men from  being  chilled.  Rest  should  be  taken  before  and  after  a 
meal. 

Hydrotherapy  is  one  of  the  most  satisfactory  factors  in  the 
treatment  of  this  disease.  Lavage  in  the  morning,  half  an  hour  be- 
fore breakfast,  the  water  containing  bicarbonate  of  soda.  If  the 
stomach  is  unirritated,  cool  or  cold  water  may  be  employed;  if  irri- 
tated, hot  water.  The  intragastric  douche  of  hot  water,  followed  by 
cold,  has  proved  very  satisfactory  in  my  hands.  Where  lavage  can- 
not be  practiced,  hot  water,  half  to  one  pint,  sipped  an  hour  before 
meals.  The  temperature  should  range  between  110°  and  150°  F.,  a 
pint  to  contain  five  grains  each  of  calcium  chloride  and  sodium  chlo- 
ride. Commence  with  mild  measures,  such  as  the  hot-air  bath  or  the 
electric  light  bath,  until  the  patient  just  perspires.  Follow  this  by  the 
wet  sheet  at  70°  F.  for  three  minutes,  with  vigorous  friction,  reduced 
three  degrees  daily  until  60°  F.  is  reached.  At  this  point  continue  the 
electric  light  bath  until  the  patient  perspires,  following  same  by  the 
horizontal  rain  or  circular  douche  at  102°  to  104°  F.  for  one  to  one 
and  a  half  minutes,  followed  by  the  fan  douche  to  the  body  and 
the  jet  douche  to  the  spine  and  legs  for  one-fourth  minute  each, 
under  fifteen  pounds  presssure,  commencing  at  a  temperature  of  70° 
F.,  reducing  two  degrees  daily  until  60°  is  reached,  and  increasing 
the  pressure  until  thirty  pounds  is  registered.  This  latter  has  in  my 
hands  proved  by  far  the  most  certain  and  satisfactory  means  of 
treatment  for  these  cases.  Where  we  have  to  deal  with  much  pain, 
the  Scottish  fan  douche  to  the  abdomen,  gradually  raising  the  tem- 
perature of  the  hot  water,  lowering  the  temperature  of  the  cold  and 
increasing  the  pressure,  will  oftentimes  give  satisfactory  relief.     Com- 


DISEASES  OF  SToM.hH  AND  INTESTINES.         235 

mence  the  douche  at  a  temperature  of  100"'  F.  for  one-half  minute, 
reduced  to  70°  F.  for  ten  seconds,  alternating  four  times ;  gradually 
increase  the  hot  water  to  108°  or  110°  F.  and  reduce  the  cold  water 
to  60°  F. 

Where  there  is  much  vomiting  of  mucus  in  the  morning,  one  may 
employ  the  ahdominal  compress  or  Neptune's  girdle  during  the  night. 
Where  the  vomiting  takes  place  immediately  after  eating,  rest  in 
bed  with  an  abdominal  compress  worn  for  two  hours,  or  Chapman's 
ice-bag  over  the  dorsal  region  of  the  spine,  should  be  utilized.  W'in- 
ternitz  has  found  the  use  of  the  cold  compress  and  cold  sitz  bath  very 
beneficial  in  these  cases,  but  the  writer's  experience  has  been  that 
the  above-suggested  treatment  does  better.  For  the  constipation  that 
so  frequently  accompanies  the  disease,  enemata  and  the  Scottish 
douche  as  above  described  applied  to  the  abdomen,  will  aid  in  its 
relief. 

It  is  my  custom  in  these  cases  to  also  use  general  massage  for  its 
tonic,  nutritional  and  circulatory  advantages.  In  those  cases  in  which 
atonic  states  exist,  local  massage  of  the  abdomen  two  hours  after  a 
meal  is  indicated.  Exercise  always  helps.  Rowing,  pulley-weight 
movements  and  general  gymnastics,  having  for  their  object  the  exer- 
cise and  movement  of  the  trunk  muscles,  tend  to  develop  a  much- 
needed  muscular  condition  of  the  abdomen,  lacking  in  these  cases.  In 
like  manner  gastro-intestinal  and  abdominal  muscular  development 
may  be  rapidly  brought  about  by  the  use  of  the  faradic  current  ex- 
ternally and  the  slowly  alternating  sinusoidal  current,  one  pole  in  the 
rectum,  the  other  applied  to  the  abdominal  muscles.  Intragastric 
faradization  acts  in  the  same  manner,  developing  both  stomach  and 
intestinal  muscle  power. 

Gastric  Atony;  Dilatation;  Intestinal  Atony. 

By  gastric  atony  is  meant  that  condition  of  the  stomach  ( or  stom- 
ach and  intestine)  characterized  by  a  weak,  flabby  condition  of  the 
muscular  apparatus,  the  result  of  which  is  to  retain  the  food  too  long 
within  its  walls.  Various  secretory  and  chemical  disturbances  of  the 
gastric  (or  intestinal)  juices  may  accompany  the  condition.  It  is 
closely  allied  to  dilatation,  and  may  be  the  primary  stage,  the  differ- 
ence being  that  in  dilatation  stretching  has  actually  taken  place — 
that  is  to  say,  non-obstructive  dilatation.  Atony  and  dilatation  bear 
a  close  relation  to  the  muscular  power  of  the  intestinal  abdominal 
wall.  This  is  necessary  to  bear  in  mind,  for  some  cases  are  unques- 
tionably due  to  this  factor  alone.  The  origin  of  these  conditions  lies 
in  those  unhygienic  conditions,  the  result  of  modern  strenuous,  high- 
pressure  life,  causing  meals  to  be  eaten  too  hastily,  accompanied  by 
over-eating,  deficient  mastication,  excesses  in  vino,  in  venery,  in  work, 
neurasthenia,  or  anv  condition  that  lowers  vitality.     In  addition,   in 


236  PRACTICAL  HYDROTHERAPY. 

women,  the  corset,  tight  waist-bands,  heavy  skirts  and  the  inexorable 
dictates  of  fashion  increase  the  number  of  victims.  The  diet  should 
consist  of  milk,  cream,  butter,  eggs,  toast,  partly  dextrinized  products 
like  shreded  wheat  biscuit,  "Force,"  grape  nuts,  etc.,  purees  of  vege- 
tables, plasmon,  beef-juice,  finely  minced  lean  meats,  rice,  corn  meal, 
hominy,  ripe  seedless  fruits  and  one  glass  of  liquid  with  each  meal. 

Hydrotherapy  is  of  the  greatest  benefit  to  these  people;  in  fact, 
there  is  no  treatment  which  compares  with  it.  The  cold  tonic  pro- 
cedures that  should  be  used  to  invigorate,  increase  appetite,  stimu- 
late the  muscular  fiber  of  the  stomach,  intestine  and  abdominal  wall, 
and  exert  an  influence  upon  the  nervous  system,  are  incomparablv 
superior  to  any  other  treatment.  Lavage  may  be  indicated,  but  the 
intragastric  douche  of  hot  and  then  cold  water — that  is  to  say,  a  Scot- 
tish douche — internally  to  the  mucous  membrane  of  the  stomach 
three  times  weekly,  on  arising,  will  develop  contractile  power  to  no 
small  extent.  Where  the  patients  are  weak  and  greatly  debilitated, 
we  may  commence  the  general  treatment  by  the  full  dry  pack  for  one 
hour,  followed  by  the  cold  sponge.  The  dry  hot  pack  mav  be  fol- 
lowed with  the  salt  rub  if  preferred,  care  being  taken  not  to  apply 
too  vigorous  friction,  it  in  its  turn  being  followed  by  a  very  rapid  cold 
sponge.  Another  valuable  method  of  treatment  is  to  administer  the 
dripping  sheet  at  70°  for  three  minutes,  with  vigorous  friction,  re- 
ducing two  degrees  daily  until  60°  F.  is  reached,  followed  by  the  cold 
sitz  bath  at  70°  for  three  to  ten  minutes.  As  soon  as  able,  the  hot-air 
bath,  or,  what  is  preferable,  the  incandescent  electric  light  bath,  to 
the  point  of  perspiration,  followed  by  the  dripping  sheet  at  70°  for 
three  minutes,  reducing  two  degrees  daily  until  60°  F.  is  reached. 
As  soon  as  this  has  developed  the  reactive  power  of  the  patient,  we 
may  continue  the  electric  light  bath  until  perspiration  takes  place, 
then  the  circular  or  horizontal  rain  bath  at  102°  to  104°  F.  for  one 
and  one-half  minutes,  followed  by  the  fan  douche  to  the  body  and 
the  jet  douche  to  the  spine  and  legs.  Commence  the  douches  at  a 
temperature  of  70°  F.  and  reduce  one  degree  daily  until  60°  F.  is 
reached.  The  pressure  should  start  at  fifteen  or  twenty  pounds  and 
gradually  be  increased  to  thirty  as  the  temperature  is  lowered. 

If  epigastric  pain  or  gaseous  distension  of  the  abdomen  is 
present,  the  Scottish  fan  douche  will  prove  most  effective  in  its  re- 
lief, as  well  as  assist  in  overcoming  constipation.  Use  as  follows: 
Electric  light  bath  to  perspiration;  fan  douche  at  104°  to  body;  Scot- 
tish fan  douche,  104°  to  110°  F.,  for  twenty  seconds  to  abdominal 
walls,  changed  to  60°  F.  for  five  to  ten  seconds,  alternating  four 
times;  finish  with  jet  douche  to  spine  and  back  of  legs  at  60°  F.  for 
five  to  ten  seconds. 

By  the  combined  use  of  the  methods  herein  suggested  I  have  seen 
these  miserable  humans   rejuvenate,  take  courage  again   and   regain 


DISEASES  OF  STOMACH  AND  INTESTINES.        237 

strength,   their   depression    leave,   and    life's    way   become   once   more 
lighted  by  the  sunshine  of  hope. 

Splanchnoptosis. 

Splanchnoptosis,  or  Glenard's  disease,  is  a  generic  term  indicating 
a  downward  displacement  of  one  or  more  of  the  abdominal  viscera. 
It  includes  gastroptosis,  enteroptosis,  nephroptosis,  etc.;  it  may  be 
one  or  all ;  they  are  often  coexistent.  Its  origin  is  most  frequently 
to  be  found  in  a  weakening  of  the  abdominal  muscles,  a  loss  of  ab- 
dominal tone,  with  a  co-operating  mechanical  cause  that  increases  the 
disability,  especially  corsets  and  heavy  skirts.  Trauma  is  a  frequent 
cause.  In  this,  as  in  many  other  diseases,  the  vital  unit  has  a  great 
influence  upon  its  inception.  Unhygienic  and  muscular-weakening 
influences,  the  result  of  the  present-day  strenuous  methods  of  life, 
with  its  ever-present  neurasthenoid  and  debilitating  influences,  has 
much  to  do  with  bringing  about  the  condition.  Its  cure  is  brought 
about  by  an  increased  strengthening  of  the  general  neuro-muscular 
system  and  a  special  developing  of  the  abdominal  muscle,  together 
with  deposition  of  fat.  Support  to  the  prolapsed  viscera  is  necessary, 
and  to  this  end  a  well-fitting  abdominal  belt  or  supporter  should  be 
adjusted.  It  has  been  the  writer's  experience  that  while  patients  are 
taking  hydrotherapeutic  and  mechanical  treatment  it  is  best  to  wear 
the  belt,  although  in  some  instances  he  has  seen  much  greater  good 
derived  from  Rose's  method  of  support  by  means  of  adhesive  plaster. 
The  diet  should  depend  on  the  functional  and  motor  power  of  the 
stomach  and  the  condition  of  the  intestine.  Plain  nutritious  food, 
tender  meats,  fish,  game,  eggs,  well-cooked  cereals,  purees  of  vegeta- 
bles, moderate  use  of  sweets,  fruits,  milk  and  cereal  coffees,  should 
be  allowed.  With  the  regulation  of  hygiene  we  may  commence  the 
use  of  the  hot-air  bath,  or,  what  is  better,  the  electric  light  bath,  to 
the  point  of  perspiration,  followed  by  the  dripping  sheet,  with  friction 
for  three  minutes,  commencing  at  a  temperature  of  70°  F.  and  re- 
ducing two  degrees  daily  until  60°  F.  is  reached.  At  this  point  we 
may  change  to  more  active  treatment ;  continue  the  electric  light  bath 
until  perspiration  takes  place,  followed  by  the  circular  or  horizontal 
rain  bath  at  102°  to  104°  F.  for  one  minute,  pressure  twenty  pounds, 
reducing  the  temperature  two  degrees  daily  until  60°  has  been  reached 
and  gradually  raising  the  pressure  one  pound  daily  until  thirty  pounds 
is  recorded.  We  may  now  safely  move  to  the  strongest  treatment — 
electric  light  bath  until  perspiration  takes  place,  this  to  be  followed 
by  the  circular  rain  bath  at  104°  F.  for  one  and  one-half  minutes. 
Finish  the  treatment  by  giving  the  fan  douche  to  the  entire  body,  es- 
pecially the  abdomen,  and  jet  douche  to  the  spine  at  a  temperature  of 
70°,  pressure  fifteen  pounds.  Lower  the  temperature  one  degree 
daily  until  60°  F.  is  reached  and  increase  pressure  two  pounds  daily 


238  PRACTICAL  HYDROTHERAPY. 

until  twenty  or  thirty  pounds  is  recorded.  Some  writers,  notably 
Kellogg,  prefer  to  finish  the  treatment  with  the  cold  plantar  douche, 
believing  that  this  materially  assists. 

In  those  cases  that  are  very  weak  and  much  run  down  the  insti- 
tution of  a  rest-cure  and  fattening  should  be  adopted,  for  which  see 
" Neurasthenia  and   Hysteria." 

Electricity  is  of  unquestioned  value,  the  author  having  found  the 
high-tension  faradic  applied  to  the  spine  and  muscles  of  the  abdomen 
especially  valuable.  The  sinusoidal  current,  slowly  alternated,  one 
pole  in  the  rectum,  the  other  applied  upon  the  abdomen,  in  sufficient 
strength  to  produce  muscular  contractions,  tones  up  those  structures 
that  are  especially  deficient.  In  these  cases  abdominal  massage  holds 
a  prominent  place.  It  should  be  administered  daily  with  general 
massage,  or  may  be  given  immediately  after  the  hydrotherapeutic 
treatment.  Special  exercises  which  have  for  their  object  the  contrac- 
tion and  movement  of  the  central  and  lateral  abdominal  and  trunk 
muscles,  will  prove  of  valuable  assistance.  Upon  recovery,  where  it 
is  deemed  necessary  to  certainly  keep  the  viscera  in  place,  Rose's 
bandage  may  be  applied.  Care  in  sitting  and  walking  should  be  ex- 
ercised by  these  patients,  a  proper  upright  position  being  at  all  times 
assumed.  Where  this  treatment  is  followed  out  persistently  most 
excellent  results  will  be  obtained  and  surgical  interference  may  be 
unnecessary. 

States  of  Hypersecretion — Hyperchlorhydria ;  Reichmann's  Disease; 
Chronic  Sthenic  Gastritis;  Gastro-Succorrhea;  Hyperchylia. 

Under  this  head  we  will  consider  those  states  in  which  the  hydro- 
chloric acid  or  the  gastric  juice  itself  is  increased.  The  background 
of  these  troubles  has,  in  my  observation,  always  been  that  of  a  per- 
turbed nervous  system,  and  I  am  of  the  opinion  that  the  increased 
secretion  of  hydrochloric  acid  is  largely  the  result  of  the  nervous  con- 
dition. This  should  be  most  diligently  sought  for  in  each  and  every 
case;  and.  as  far  as  possible,  worries,  overexcitement,  business  cares 
and  the  strains  of  life  eliminated.  The  diet  must  not  contain  irritating 
food,  such  as  condiments,  salt,  pepper,  sauces,  vinegars,  etc. ;  albu- 
minoids should  be  restricted,  and  milk,  eggs,  well-cooked  cereals, 
toast,  zwieback,  butter,  moderate  amount  of  fats,  vegetables  as 
purees ;  potatoes,  baked,  boiled  or  mashed,  with  butter,  cream  and 
milk,  macaroni,  spaghetti,  spinach,  baked  sweet  apples,  ripe  peaches, 
pears,  oranges,  bananas  and  white  grapes  taken.  Meats  once  daily, 
the  lean  parts  finely  divided,  hamburger  steak  without  seasoning,  fish, 
chicken,  turkey,  etc.  As  beverages,  water.  Vichy,  seltzer,  Apollinaris 
and  cereal  coffees  may  be  used.  Plenty  of  sleep  must  be  secured  and 
moderate  fresh-air  exercise  indulged  in.  Golf  is  especially  valuable  in 
these  conditions,  though  horseback  riding  and  driving  may  be  utilized. 


DISEASES  OF  STOMACH  AND  INTESTINES.         23) 

Hydrotherapeutics  are  valuable,  and  alone  are  sufficient  to  cure  the 
disease.  We  can  commence  by  using  the  hot  fomentation  an  hour 
before  meals  in  conjunction  with  the  other  methods  to  be  hereinafter 
mentioned.  Where  recourse  cannot  be  had  to  institutional  treatments, 
we  may  employ  the  hot  full  bath  at  105°  F.  for  ten  minutes,  followed 
by  a  rapid  cold  sponge,  care  being  taken  to  keep  the  head  cool  during 
its  application.  Another  satisfactory  method,  strongly  endorsed  by 
European  authority,  is  the  use  of  the  cold  sitz  bath  at  60°  to  50°  F. 
for  five  to  ten  minutes,  followed  by  the  stimulating  abdominal  com- 
press. 

Institutional  treatment  offers  the  most  satisfactory  method  for 
these  cases.  Commence  with  the  hot  air  bath,  or,  what  is  better,  the 
incandescent  electric  light  bath,  to  the  point  of  perspiration,  followed 
by  the  use  of  the  dripping  sheet,  with  friction,  at  a  temperature  of  70° 
for  three  minutes,  repeated  daily,  lowering  the  temperature  two  de- 
grees until  60°  is  reached.  At  this  point  we  should  change  the 
treatment ;  continue  the  use  of  the  electric  light  bath  or  hot  air 
until  free  perspiration,  followed  by  the  circular  or  horizontal  rain 
bath  at  a  temperature  of  102°  to  104°  F.  for  one  and  one-half  min- 
utes; follow  this  by  the  fan  douche  to  the  body  ten  to  fifteen  sec- 
onds and  jet  douche  to  the  lower  limbs  ten  to  fifteen  seconds,  at  a 
temperature  of  70°  F.,  pressure  twenty  pounds.  Reduce  temperature 
of  douches  two  degrees  daily  to  60°  F.,  increasing  pressure  two  pounds 
until  thirty  pounds  is  reached.  We  may,  if  we  choose,  on  alternate 
days  substitute  the  salt  rub  or  glow  for  the  electric  light  bath,  although 
the  writer  has  found  the  preceding  application  much  more  satisfac- 
tory. From  some  experimental  work  upon  the  value  of  these  treat- 
ments in  states  of  hypersecretion,  the  writer  feels  warranted  in  stating 
that  these  alone  are  sufficient  to  bring  about  a  cure,  but  in  conjunction 
with  them  certain  auxiliary  methods  will  decidedly  help. 

Intragastric  faradization  with  a  high-tension  fine-wire  coil,  as  sug- 
gested by  Reed,  has  proved  of  benefit  in  checking  the  secretion  of  gas- 
tric juice,  applied  three  times  weekly.  General  massage,  avoiding  the 
abdomen,  will  be  found  a  satisfactory  alternate  with  intragastric  farad- 
ization. Medicinal  treatment  is  unsatisfactory,  although  the  judicious 
and  careful  use  of  diastatic  preparations,  especially  "Takadiastase," 
and  the  alkalies  have  given  relief.     The  bromides  sometimes  help. 

Gastric  Ulcer;  Duodenal  Ulcer. 

Gastric  ulcer  is  a  circumscribed  solution  of  continuity  involving 
the  mucous  membrane  and  one  or  more  layers  of  the  stomach  walls, 
characterized  by  pain,  hyperchlorhydria,  disorders  of  digestion  and 
vomiting  of  blood.  Gastric  ulcer  is  comparatively  rare,  but  originates 
most  frequently  from  the  corroding  action  of  an  excessively  strong 


240  PRACTICAL  HYDROTHERAPY. 

gastric  juice  rich  in  hydrochloric  acid,  and  occurs  especially  where 
the  patient  is  the  subject  of  marked  anemia  or  chlorosis.  Some  ulcer- 
ations occur  in  the  duodenum,  especially  following  extensive  super- 
ficial burns  of  the  cutaneous  surface.  The  auto-digestion  of  the 
mucous  membrane  occurs  when  the  vitality  is  low,  and  where  this 
condition  is  coupled  with  hyperchlorhydria  one  should  always  suspect 
gastric  ulcer.  The  powerful  tonic,  restorative  and  corrective  power 
of  hydrotherapy  over  these  conditions  make  it  the  treatment  par  ex- 
cellence, acting  as  it  does  in  removing  causal  factors  and  relieving 
present  conditions.  The  treatment  should  have  for  its  object  the  com- 
plete rest  of  the  stomach,  to  modify  the  gastric  secretion  and  restore 
the  vital  resistance.  Absolute  rest  in  bed  for  three  to  six  weeks  is 
essential,  and  for  the  first  two  or  three  weeks  rectal  feeding  three 
times  daily  is  necessary.  This  should  be  preceded  by  the  normal 
saline  solution,  and  the  nutritive  enema  may  consist  of  milk  four 
ounces,  two  eggs  well  beaten  up,  a  pinch  of  salt,  all  predigested  by 
pancreatin.  Reed  suggests  the  use  of  milk,  freshly  expressed  meat 
juice,  meat  powders,  beef  juice,  raw  eggs,  solution  of  sugar,  butter  or 
olive  oil,  and  well  cooked  solutions  of  starch.  Ewald's  plan  is  to  use 
two  or  three  eggs  beaten  up  with  a  tablespoonful  of  cold  water;  a 
tablespoon ful  of  prepared  cereal,  dextrinized  by  heat,  is  boiled  with 
half  a  tumbler  of  a  20  per  cent,  solution  of  grape  sugar,  and  a  wine- 
glassful  of  claret  added.  When  lukewarm,  stir  in  the  eggs  and  add 
fifteen  grains  of  salt.  Return  to  feeding  may  begin  with  milk  and 
lime  water,  equal  parts ;  milk,  lime  water,  barley  water,  equal  parts ; 
then,  as  judgment  suggests,  soft-boiled  or  poached  egg,  calf's-foot 
jelly,  purees  of  vegetables  strained,  so  that  by  the  end  of  six  weeks 
well-cooked  cereals,  "Force,"  grape  nuts,  cream  of  wheat,  stale  bread, 
butter,  etc.,  are  in  the  dietary.  For  months  the  patient  must  avoid  alco- 
hol, beers,  wines,  tobacco,  condiments,  acids,  vinegars,  excess  of  salt, 
hard  food  and  coarse  vegetables.  The  hydrotherapeutic  treatment  of 
this  trouble  should  consist  of  measures  that  relieve  the  pain,  lessen 
the  formation  of  hydrochloric  acid  and  diminish  gastric  activity.  This 
is  best  accomplished  by  the  use  of  the  hot  fomentation  for  fifteen  to 
twenty  minutes,  followed  by  the  hot  abdominal  compress,  well  cov- 
ered with  flannel,  over  which  may  be  placed  oil  silk.  The  flannel  must 
be  wrapped  around  the  body  in  such  a  way  as  to  prevent  the  loss  of 
heat. 

Sadger1  believes  in  powerful  stimulating  general  and  local  meas- 
ures. He  finds  that  the  abdominal  pack  at  60°  F.,  changed  every  four 
hours,  in  conjunction  with  a  coil  inserted  in  the  pack  once  or  twice  a 
day,  and  through  which  water  at  104°  F.  (40°  C.)  is  allowed  to  flow,  an 
excellent  measure.  As  soon  as  possible  he  adds  to  this  a  sitz  bath  at 
46°  to  .55°  F.  for  three  to  five  minutes  once  daily.     In  the  morning  a 

1  Berliner  klinische  Wochenschrift,  April  14,   1906. 


DISEASES  OF  STOMACH  AND  INTESTINES.        241 

rapid  cold  sponge  is  given,  avoiding  chest  and  abdomen.  A  good 
arrangement  for  home  use  is  a  cold  pack  until  the  sheet  gets  warm 
(twenty  to  thirty  minutes),  with  a  half  bath  afterward  at  22°  or  20° 
C.  (68°  F. )  for  two  or  three  minutes.  Milk  is  the  only  food  he  al- 
lows for  four  or  five  weeks,  commencing  with  a  teaspoon ful  every 
fifteen  minutes.  He  increases  the  amount  to  a  tablespoon  ful,  then  to 
half  an  after-dinner  coffeecupful,  and  finally  to  a  teacup  ful,  lengthen- 
ing the  intervals  to  thirty  to  sixty  minutes.  He  insists  on  this  diet 
after  acute  hemorrhage,  and  also  in  the  treatment  of  chronic  ulcer. 
Even  on  the  day  of  the  hemorrhage  it  is  possible  to  commence  with 
minimal  amounts  of  the  milk  (ice  cold).  The  milk  must  always  be 
very  slowly  sipped. 

By  these  methods  much  good  may  be  accomplished  in  conjunc- 
tion with  the  dietetic,  hygienic  and  medicinal  treatment  of  the  dis- 
ease. In  hemorrhage  no  ice  or  cold  drinks  must  be  taken  into  the 
stomach,  as  they  will  actually  favor  hemorrhage  when  the  water  ac- 
cumulates and  becomes  warm.  A  cold  compress  should  be  placed 
over  the  stomach,  and  upon  this  the  cold  coil  or  ice-bag  (not  too 
heavy)   may  be  laid,  keeping  same  up  for  a  week. 

States    of    Hyposecretion  —  Hypochlorhydria;    Achlorhydria;    An- 
acidity;  Hypochylia;  Achylia  Gastrica;  Hypopepsia;  Apepsia. 

Under  this  head  we  embrace  those  conditions  marked  by  the  dimi- 
nution or  absence  of  hydrochloric  acid  in  the  gastric  juice.  It  must  be 
borne  in  mind  that  there  are  numbers  of  instances  in  which  the  dimi- 
nution or  absence  of  the  hydrochloric  content  is  not  due  to  the  condi- 
tions we  are  here  discussing,  being  brought  about  by  such  diseases  as 
asthenic  gastritis,  amyloid  degeneration,  atrophy,  carcinoma,  etc.  It 
is  not  intended  to  otherwise  than  convey  the  idea  of  a  condition  of 
suppression  or  absence,  generally  of  a  nervous  or  neurotic  origin, 
and  not  dependent  upon  organic  structural  lesions,  consequent  upon 
or  sequential  to  other  disease.  The  writer  has  seen  quite  a  number 
of  achlor-  and  hypochlorhydric  cases,  although  they  form  a  small 
class  in  his  experience  compared  to  the  hyperchlorhydric  group.  They 
are  usually  constructed  upon  a  neurotic,  neurasthenic  or  devitalized 
basis.  Hygienic  errors,  absence  of  fresh  air,  mental  worry  and  strain, 
loss  of  sleep,  digestive  errors  and  indiscretion,  all  lead  to  its  produc- 
tion. In  passing,  we  may  say  that  the  treatment,  to  be  successful, 
must  be  continued  over  a  lengthy  period.  The  patient  should  avoid 
all  rich  foods,  gravies,  much  meats,  pickles,  cane  sugars  and  confec- 
tions. Every  effort  should  be  made  to  preserve  and  stimulate  the 
secretion  of  hydrochloric  acid.  Hydrotherapy  alone  is  sufficient  to 
bring  this  about,  its  value  having  been  fully  determined  by  me  in  a 
number  of  cases  carefully  studied  with  this  in  view.  Where  there  is 
any  tendency  to  weak  muscular  power  and  stagnation  of  the  gastric 


242  PRACTICAL  HYDROTHERAPY. 

contents  we  must  have  recourse  to  lavage.  After  cleansing  the  stom- 
ach, several  washes  should  be  made  with  hot  water,  followed  by  cold 
water,  thus  subjecting  the  mucous  membrane  of  the  stomach  to  the 
influence  of  the  Scottish  douche.  To  stimulate  appetite  and  the  flow 
of  gastric  juice,  drink  half  a  glass  of  cold  water  one  hour  before  meals 
and  put  an  ice-bag  over  the  stomach  for  an  hour  before  eating.  Gen- 
eral hydrotherapeutic  methods  are  most  valuable,  as  they  tone  up  the 
relaxed  musculature,  increase  secretions  generally,  and  improve  nerve 
force.  Commence  with  the  electric  light  bath  or  hot-air  bath  until 
perspiration.  This  may  be  followed  by  the  dripping  sheet  with  fric- 
tion at  a  temperature  of  70°  F.  for  three  minutes,  lowered  two  de- 
grees daily  until  60°  F.  is  reached.  Reaction  must  be  secured.  As 
soon  as  established  we  should  commence  with  the  electric  light  bath 
or  hot  air  until  perspiration,  followed  by  the  salt  rub  with  sufficient 
friction  to  redden  the  skin,  followed  by  the  horizontal  or  circular  rain 
bath  at  104°  F.  for  one  and  one-half  minutes,  reduced  to  80°  F..  under 
twenty  pounds  pressure :  reduce  two  to  three  degrees  daily  until  60° 
F.  is  reached  and  raise  the  pressure  two  pounds  daily  to  thirty  pounds. 
When  this  point  is  reached  we  may  now  follow  the  rain  bath  by  the 
fan  douche  applied  to  the  body  for  five  to  ten  seconds,  and  the 
jet  douche  to  the  spine  for  five  to  ten  seconds,  at  a  temperature 
of  60°  F..  thirty  pounds  pressure.  Especial  pains  should  be  taken  to 
have  the  jet  strong  in  the  dorsal  region  opposite  the  stomach.  As 
soon  as  the  improvement  is  marked  the  following  hydriatic  treatment 
should  succeed  the  others :  The  daily  use  of  the  electric  light  bath  or 
hot-air  bath  to  perspiration ;  horizontal  rain  bath  at  104c  F.  for  one 
and  one-half  minutes;  the  fan  douche  to  the  entire  body  for  one- 
fourth  minute:  the  jet  douche  to  the  spine  one-third  minute  and  to 
the  abdominal  wall  for  one-fourth  minute,  at  a  temperature  of  60° 
F..  under  a  pressure  of  twenty  or  twenty-five  pounds.  It  is  sometimes 
marvelous  to  contemplate  the  changes  that  will  take  place  under  the 
powerful,  stimulating  and  perturbating  influence  of  this  treatment. 
Cases  that  were  apparently  hopeless  take  on  new  life  and  vigor,  and 
respond  to  the  treatment  with  a  reaction  to  which  they  had  been 
strangers  for  many  years. 

Auxiliary  treatment  I  have  found  of  considerable  value,  especially 
central  galvanization,  the  large  negative  pad  being  applied  over  the 
abdominal  sympathetic,  the  positive  over  the  cervical.  The  static 
wave  current  (Snow),  using  a  large  block-tin  pad  applied  over  the 
abdomen,  is  a  valuable  treatment.  Manual  massage  and  mechanical 
vibration  in  connection  with  the  slowly  alternated  sinusoidal  current 
will  aid  hydrotherapy  in  rapidly  toning  up  the  local  structures  of  the 
abdominal  wall  of  stomach  and  intestines,  increasing  secretion,  favor-. 
ing  elimination  and  overcoming  constipation. 

These  cases  should  be  urged,  where  it  is  possible,  to  indulge  in 


DISEASES  OF  STOMACH  AND  INTESTINES.         243 

swimming  after  they  have  been  relieved  of  the  disease.  Surf  bathing 
offers  probably  the  best  post-treatment  we  have,  combining  as  it  does 
fresh  air,  exercise  and  the  stimulating  percussory  influence  of  the  saline 
water  upon  the  skin.  The  duration  of  an  immersion  in  the  surf  should 
be  brief,  followed  by  a  rub  down  and  short  walk. 

Acute    Intestinal    Catarrh;    Acute    Enteritis;    Acute    Entero-Colitis; 

Acute   Gastro-Entero-Colitis  of  Children;   Cholera  Infantum; 

Summer  Diarrhea;  Summer  Complaint;  Acute  Diarrhea. 

The  above  states  are  due  to  acute  inflammations  of  the  mucous 
membrane  lining  the  intestinal  tube,  characterized  by  pain,  tenderness 
and  loosenesss  of  the  bowels ;  in  some  fever  is  present.  There  is  no 
question  but  that  in  a  great  many  cases  the  disease  is  due  to  the  pres- 
ence of  micro-organisms,  which  have  been  ingested  and  multiplied  in 
the  intestinal  canal.  In  others,  ptomaines,  offensive  and  irritating 
food  and  exposure  are  the  determining  factors.  In  all,  the  first  ele- 
ment should  be  the  prompt  removal  of  the  offending  mass ;  if  the  case 
is  vomiting,  wash  out  the  stomach  with  hot  water,  followed  by  the 
ice-bag  to  the  external  surface.  The  copious  drinking  of  hot  water 
is  indicated ;  this  should  be  administered  in  teaspoon ful  doses  and  in 
small  children  by  nursing  bottle.  All  food  must  be  withdrawn.  Where 
calomel  is  indicated  this  may  be  administered  as  a  dry  powder  upon 
the  tongue  in  one-sixth  to  one-fourth  grain  doses,  repeated  every 
thirty  minutes  until  a  grain  or  two  have  been  taken.  The  bowels 
should  be  immediately  and  thoroughly  emptied  by  means  of  a  hot 
saline  enema,  temperature  105°  to  110°  F.,  and  repeated  at  least  twice 
daily  as  needed.  By  this  means  the  calomel  will  cleanse  the  small  in- 
testine, and  the  enema,  by  irrigating  the  colon,  removes  the  mucus, 
bacteria,  fermenting  material  and  food.  The  absolute  abstention  from 
food  neutralizes  the  efficiency  of  germ  life,  removes  its  nutrient  me- 
dium and  reduces  intestinal  activity  to  a  minimum.  In  the  cases  oc- 
curring in  children,  the  hot  full  pack,  until  hyperemia  of  the  skin  takes 
place,  followed  by  the  cold  sponge  rapidly  performed,  is  indicated. 
If  fever  is  high,  use  the  wet  pack  at  70°  F.,  reduced  each  time  two 
degrees  until  60°  F.  is  reached,  at  which  temperature  it  is  to  be  main- 
tained. It  should  be  repeated  every  three  hours  if  necessary,  its  rep- 
etition being  regulated  by  the  general  condition  and  fever.  In  adults 
the  cold  sitz  bath  (70°  to  50°  F.),  ten  to  thirty  minutes'  duration, 
is  a  valuable  method,  and  the  author  can  speak  in  unmeasured  terms 
in  its  praise,  it  having  in  his  hands  yielded  some  brilliant  results.  Its 
action  is  to  lessen  peristalsis  and  produce  an  anemia  of  the  mucous 
membrane.  In  a  member  of  his  own  family  this  measure  has  accom- 
plished, in  acute  exacerbations  and  chronic  states,  results  most  prompt 
and  satisfactory.  There  are  cases  in  which  appear  nervous  collapse, 
prostration  and  inanition,  and  in  whom  shock  is  well  marked,  due  to 


244  PRACTICAL  HYDROTHERAPY. 

the  diarrhea  and  absorption  of  ptomaines ;  in  these  cases  the  nervous 
system  is  profoundly  involved,  showing  apathy,  pallor  and  cold  extrem- 
ities. They  present  many  of  the  symptoms  of  the  so-called  "typhoidal 
state."  The  indication  is  the  full  bath  at  90°  F.  for  seven  to  ten  min- 
utes, repeated  two  or  three  times  daily.  Do  not  be  swerved  from  the 
procedure  by  any  cry  or  protest ;  be  kind,  but  firm.  The  friction  should 
be  gentle,  the  patient  removed  to  the  sheet,  covered  and  packed  with 
blankets.  The  remarks  made  covering  typhoid  fever  bear  on  these 
cases  with  this  distinction  and  difference,  that  in  intestinal  troubles  a 
more  decided  reaction  must  be  sought. 

"The  object  of  this  bath  is  not  alone  to  reduce  temperature,  al- 
though this  is  an  important  incidental  result.  We  have  here  a  vaso- 
motor paralysis,  as  evidenced  by  the  pallor  of  the  entire  body,  even 
when  a  high  temperature  is  registered  in  the  rectum.  By  immersing 
the  entire  body  in  tepid  water  we  produce  a  mild  cutaneous  excitation, 
which  is  gradually  increased  by  the  removal  of  warmth  and  the  addi- 
tion of  cold  water,  and  is  enhanced  by  frictions  of  the  body  and  con- 
stant agitation  of  the  cooling  water  against  the  skin.  These  gentle 
shocks  are  not  beyond  the  child's  reactive  capacity ;  they  are  suc- 
ceeded by  equally  gentle  reactions,  so  that  the  cutaneous  vessels  dilate, 
as  evidenced  by  redness  of  the  skin.  If,  in  addition,  the  face  and  head 
are  bathed  with  water  at  60°  F.  or  below,  the  shock  and  reaction  are 
increased,  the  respiration  deepens,  and  the  heart  beats  with  more 
vigor  and  less  rapidity,  the  eye  brightens,  the  color  returns  to  the 
lips,  the  child  becomes  more  animated."     (Baruch.) 

The  bath  may  be  preceded  by  a  draught  of  hot  water  and  the 
dry  full  pack  where  fever  does  not  exist.  Should  collapse  supervene 
at  any  time,  the  hot  full  dry  pack,  hot-water  drinking  and  the  ice-bag 
to  the  precordia  will  be  found  most  useful.  The  return  to  food  must 
be  along  the  line  of  sterile,  pasteurized  milk,  graduated  diet,  etc. 

Acute  Dysentery;   "Bloody   Flux";   Acute   Colitis;   Acute   Proctitis. 

This  is  a  group  of  acute  inflammations  of  the  mucous  membrane 
of  the  large  intestine  from  the  ileo-cecal  valve  to  the  anus.  The  in- 
flammation is  mostly  catarrhal,  sometimes  ulcerative,  and  is  charac- 
terized by  fever,  pain,  tenesmus  and  bloody  stools.  It  originates  most 
frequently  in  this  country  from  errors  in  diet,  exposure  to  cold,  wet 
and  general  unhygienic  conditions.  Since  the  return  of  our  soldiers 
from  the  Hispano-American  war  we  have  had  added  the  amebic  or  trop- 
ical form,  due  to  the  presence  of  the  ameba  coli,  in  the  ulcerations  of 
the  colon,  stools,  etc. ;  of  these  the  author  has  had  a  few  to  deal  with. 
Another  form  is  caused  by  the  bacillus  of  Shiga,  possessing  flagella 
and  motility.  This  bacillary  dysentery  is  now  found  both  in  the  tem- 
perate and  tropical  climates  of  our  country.  Infection  occurs  usually 
by  means  of  the  generous  drinking  of  water,  or  food  that  has  come 
in  contact  with  or  been  contaminated  by  discharges.  In  the  treatment 
of  these  cases  rest  in  bed  is  an  essential,  and  overexertion  on  the  pa- 


DISEASES  OF  STOMACH  AND  INTESTINES.        245 

tient's  pari  is  best  avoided,  the  bed-pan  being  used  and  all  discharges 
sterilized  with  chlorinate  of  lime  or  ferrous  sulphate.  Liquid,  hland 
diet,  such  as  peptonized  or  predigested  milk,  liquid  peptonoids,  broths, 
egg-albumen,  etc.,  should  be  employed.  The  first  measure  in  the  treat- 
ment of  this  disease  is  irrigation  of  the  entire  colon  by  hot  water  at 
a  temperature  from  105°  to  110  F.,  to  remove  any  offending  food, 
bacteria  or  irritative  material,  which  will  give  the  bowel  a  much-needed 
pest.  After  this  the  rectum  may  be  irrigated  with  cold  water  (55° 
to  60°  F.),  repeated  every  two  hours.  It  has  been  suggested  to  mix 
this  water  with  alum,  creolin  and  other  drugs,  and  they  may  be  added, 
although  the  author  has  never  observed  this  to  be  of  marked  value. 
In  amebic  dysentery  a  1-2500  solution  of  quinine,  as  suggested  by 
Lorsch.  has  proved  of  value.  These  irrigations  will  relieve  the  inflam- 
mation, lessen  the  distension,  diminish  the  stools,  decrease  the  pain  and 
tenesmus  and  add  materially  to  the  patient's  comfort. 

Hydrotherapy  is  of  unquestioned  value.  The  plan  originally  sug- 
gested by  Winternitz,  and  ably  advocated  by  Strassel,  has  given  the 
author  very  great  satisfaction,  both  in  acute  and  chronic  conditions. 
It  is  the  dripping  sheet,  commencing  with  a  temperature  of  80°  F. 
and  reducing  two  or  three  degrees  daily  until  60°  F.  is  reached,  fol- 
lowed by  the  cold  sitz  bath  (75°  to  60°  F.)  for  eight  to  fifteen,  even 
twenty  minutes.  Kellogg  suggests  the  addition  of  the  hot  foot-bath 
during  the  administration  of  the  sitz,  and -there  is  no  objection  to  this, 
as  it  will  increase  the  efficacy  of  the  cold  sitz  and  make  the  pa- 
tient much  more  comfortable;  its  temperature  should  be  from  105° 
to  115°  F.  An  important  element  in  the  administration  of  the  sitz 
bath  is  gentle  rubbing  to  the  abdomen  during  its  continuance.  The 
rationale  of  this  is  to  assist  in  maintaining  tonic  dilatation  of  the 
surface  blood-vessels  correlated  to  the  intestines,  for  its  aim  is  to  pro- 
duce an  anemia  of  the  intestine,  to  lessen  secretion  and  diminish  peri- 
stalsis. Where  it  is  not  possible  to  administer  the  above  treatment. 
the  hot  dry  half  pack,  given  for  thirty  minutes,  followed  by  the  ab- 
dominal compress  at  60°  F.  for  half  to  one  hour,  frequently  repeated, 
will  oftentimes  prove  of  service.  The  wet  pack,  70°  to  60°  F.  for  one 
or  two  hours,  followed  by  the  half  bath,  will  sometimes  overcome  the 
marked  adynamia  that  exists  in  these  cases.  Where  it  is  desired  to 
stimulate  the  general  vital  and  resistive  powers,  the  cold  sponge  may 
be  employed  every  three  or  four  hours,  as  is  indicated.  The  author 
has  found  tannalbin  of  some  value  in  connection  with  these  treatments. 

Chronic   Enteritis;    Chronic    Entero-Colitis;    Chronic   Intestinal   Ca- 
tarrh; Chronic  Diarrhea;  Chronic  Dysentery;  Chronic  Colitis; 
Chronic  Proctitis. 

The  above  group  of  chronic  inflammatory  diseases  of  the  intes- 
tines, small  and  large,  are,  as  a  rule,  the  flotsam  and  jetsam  of  acute 


246  PRACTICAL  HYDROTHERAPY. 

attacks ;  the  inflammation,  congestion  and  frequent  stools  remain, 
changed  some  in  character,  hut  in  general  bearing  much  resemblance 
to  the  acute.  The  pain  and  suffering  are  not  as  marked,  although 
these  cases  become  weak,  emaciated,  lose  vitality  and  strength,  are 
anemic,  dyspeptic,  and  the  subjects  of  auto-intoxication.  Many  are 
markedly  neurasthenoid,  even  melancholic,  have  tried  many  men  and 
many  things  until  at  last  they  lose  hope,  mere  existence  becoming 
their  lot.  I  do  not  hesitate  to  state  that  in  these  cases  most  brilliant 
results  have  been  obtained  by  hydrotherapy,  and  instead  of  dreading  to 
deal  with  these  formidable  maladies  their  treatment  becomes  simple, 
the  result  excellent  where  persistent  treatment  commensurate  with  the 
duration  of  the  disease  is  persisted  in.  The  diet  must  always  be  reg- 
ulated, be  bland  and  unirritating — predigested  milk,  peptonoids,  soups, 
broths,  vegetable  purees,  dextrinized  cereals,  koumyss,  plasmon,  tropon, 
tender  meats,  fowls,  fresh  fish,  eggs,  spinach,  well-cooked  rice,  etc. 
The  hygiene  and  life  must  be  regulated,  and  our  aim  should  be  to 
increase  vital  power  and  resistance  by  all  means  at  hand ;  regulate 
the  diet  so  as  to  render  the  intestine  a  poor  culture-medium,  by  local 
therapeutics  to  remove  those  products  that  will  produce  further  irri- 
tation and  inflammation ;  to  inhibit  their  action  by  germ-destroying 
applications,  and  through  hydrotherapy  improve  the  internal  circula- 
tion, lessen  secretion  and  diminish  peristalsis  until  a  normal  condition 
is  reached.  The  most  satisfactory  method  of  treatment,  and  one  that 
has  proved  in  my  hands  of  almost  unerring  value,  is  the  method  of 
Winternitz. 

The  patient,  standing  in  a  hot  foot-bath  at  110°  F.,  is  given  the 
dripping  sheet,  commencing  at  a  temperature  of  70°  F.  for  three  min- 
utes, this  temperature  to  be  reduced  three  degrees  daily  until  60°  F. 
is  reached.  This  is  followed  by  the  cold  sitz  bath  at  80°  F.,  reduced 
three  degrees  daily  to  60°  F.,  or  even  50°  F.  Its  duration  should 
be  ten  to  fifteen  minutes.  After  the  rub,  the  patient,  without  being 
dried,  immediately  occupies  the  cold  sitz  bath,  is  thoroughly  covered 
and  rubs  the  abdomen  vigorously.  The  action  of  the  cold  water  upon 
the  sensory  nerves  of  the  skin,  accompanied  by  friction,  causes  a  tonic 
circulation  of  blood  in  the  cutaneous  surface,  as  a  result  of  which 
bowel  secretion  is  reduced,  circulation  modified  and  peristalsis  checked. 
With  a  cessation  or  improvement  of  the  intestinal  symptoms  we  may 
move  to  general  treatment  calculated  to  restore  the  devitalized  and 
depreciated  state  of  the  patient.  In  the  treatment  of  these  cases  the 
Turkish  bath,  hot  air  and  electric  light  bath  have  been  much  employed, 
in  conjunction  with  an  ice-bag  applied  to  the  stomach  and  bowel. 
The  author  has,  however,  found  the  use  of  the  incandescent  electric 
light  bath  until  perspiration,  the  horizontal  rain  bath  at  100°  F.  for 
one  minute  reduced  to  65°  for  ten  seconds,  followed  by  the  cold  sitz 
bath  at  60°  F.   for  ten  minutes,  accompanied  by  vigorous   friction,  a 


DISEASES  OF  STOMACH  AND  INTESTINES.         247 

most  valuable  method  of  treatment.  To  enhance  its  effect  he  sometimes 
uses  the  hot  foot-bath  at  110°  F.  In  conjunction  with  this  treatment 
we  may  employ  enemata  of  nitrate  of  silver,  ten  to  thirty  grains  to 
the  pint  of  distilled  water ;  normal  saline ;  boric  acid,  five  grains  to 
the  ounce;  tannic  acid,  one  or  two  drachms  to  the  pint.  The  author's 
experience  has  been  that  the  best  results  are  obtained  by  the  use  of  the 
normal  saline,  followed  by  medicated  applications,  of  which  the  best 
is  the  aqueous  extract  of  krameria  in  2  to  10  per  cent,  strengths,  as 
originally  suggested  by  Tuttle.  Associated  treatment  materially  helps, 
especially  massage,  avoiding  the  abdomen  and  lower  spine.  The  static 
wave  current  to  the  abdomen  is  a  measure  of  no  small  value. 

Constipation. 

Constitpation  may  be  defined  as  a  functional  inactivity,  a  slug- 
gishness of,  or  an  imperfect  emptying  of  the  bowel.  This  may  be 
either  due  to  atony  of  the  muscular  coat  or  deficiency  of  secretions. 
It  is  a  symptomatic  condition,  having  its  origin  in  many  causes,  and, 
in  its  turn,  provoking  disease  or  aggravating  existing  conditions.  It 
is  the  bane  of  civilization.  It  causes  especial  irritation  to  nervous 
people,  and  produces  many  unpleasant  symptoms  associated  with  the 
cerebral  and  spinal  functions,  especially  fullness  of  the  head,  mental 
depression,  headache  and  neurasthenic  symptoms.  It  deranges  the 
digestion,  causes  dyspeptic  symptoms,  and  in  many  instances  is  mis- 
taken for  "indigestion,"  so-called.  Through  its  influence  the  system  is 
loaded  with  toxins,  producing  sallow  skin,  anemia  and  a  host  of  other 
conditions.  It  throws  a  great  deal  of  the  labor  of  elimination  upon 
the  kidney,  and  has,  in  the  writer's  observation,  caused  a  form  of 
pseudo-Bnght's  disease,  in  which  a  trace  of  albumin,  cylindroids, 
many  crystals  of  uric  acid,  oxalate  of  lime  and  indican  are  present. 
Its  origin  is  to  be  most  frequently  found  in  those  of  sedentary  habits, 
who  lead  an  indoor  life  and  who  take  little  exercise;  who  wear  im- 
proper clothing;  who  indulge  in  improper  food  and  who  overeat; 
in  those  who  are  irregular  and  careless  in  the  act  of  defecation  and 
who  are  habitual  users  of  laxatives.  The  essential  element  in  the 
treatment  is  to  remove  the  atony  of  the  intestine,  which  is  found 
especially  in  neurotics  and  neurasthenics ;  to  increase  the  secretion, 
thus  overcoming  the  dry  fecal  mass ;  to  strengthen  the  relaxed  and 
weakened  abdominal  muscles.  The  first  thing  to  be  done  is  to  stop 
the  use  of  drugs  and  warm  enemata,  for  we  will  find  that  it  is  to 
hygiene,  diet,  baths  and  electricity  that  we  must  look  for  a  cure. 
Enemas  and  medicines  aggravate  the  disease  by  causing  paresis  of  the 
intestinal  wall,  and  are  apt  to  be  followed  by  dilatation  of  the  colon. 
Most  of  these  cases  drink  little  water,  and  for  that  reason  they  should 
be  made  to  ingest  large  quantities,  unless  they  are  at  the  same  time 
the  subject  of  splanchnoptosis.     The  use  of  cold  carbonated  waters 


248  PRACTICAL  HYDROTHERAPY. 

— \  ichy,  seltzer,  etc. — before  breakfast  is  more  advantageous  than 
plain.  A  regular  hour  for  stools  should  be  selected  and  adhered  to 
strictly.  Exercise  in  the  open  air,  such  as  horseback  riding,  rowing 
and  golf,  are  to  be  recommended,  as  are  regular  hours  in  eating. 
The  diet,  if  possible,  should  be  such  as  will  leave  some  refuse  or 
residue.  Penzoldt  suggests  the  following  diet:  7  a.m.,  one  glass  of 
cold  water;  8  a.m.,  generous  breakfast  of  sweetened  coffee,  much 
butter,  honey,  graham  or  brown  bread;  1  p.m.,  dinner  of  meat,  much 
vegetables,  salad,  stewed  fruit,  farinaceous  foods,  cider  or  fruit  juices; 
7  p.m.,  meat  with  much  butter,  graham  bread,  stewed  fruit;  10  p.m.. 
before  going  to  bed,  fresh  or  stewed  fruit.  Fruits  are  of  especial  ad- 
vantage, such  as  figs,  oranges,  pears,  stewed  prunes,  baked  apples, 
as  are  nuts,  brown  bread  and  molasses.  Xo  alcohol,  beer  or  wine 
should  be  used.  The  application  of  hydrotherapy  acts  as  a  tonic  to 
the  nervous  system,  increases  the  contraction  of  the  abdominal  walls, 
stimulates  the  secretion  and  favors  elimination.  A  number  of  meth- 
ods have  been  suggested.  Winternitz  prefers  the  use  of  the  dripping 
sheet  at  60°  F.  for  three  minutes,  with  vigorous  friction,  followed 
by  the  cold  sitz  bath  (50°  to  70°  F.)  for  two  to  five  minutes.  There 
is  no  question  but  what  a  cold  sitz  of  short  duration  stimulates  the 
muscular  contraction  of  the  intestine  and  increases  secretion.  The 
writer,  however,  has  found  that  douches  applied  to  the  abdominal 
wall  are  more  satisfactory,  especially  the  cold  fan  and  jet  douche 
of  brief  duration  to  the  abdominal  wall  and  spine.  Commence  with 
the  electric  light  bath  or  hot-air  bath  until  profuse  perspiration  takes 
place.  Foliow  with  the  horizontal  or  circular  rain  bath  at  105°  F. 
for  one  minute,  pressure  twenty  pounds ;  then  the  fan  douche  to  the 
body  for  one-fourth  minute  and  the  jet  douche  to  the  spine  for  one- 
fourth  minute,  commencing  at  a  temperature  of  70°  F.,  twenty  pounds 
pressure,  reducing  the  temperature  two  degrees  daily  to  60°  F.,  and 
increasing  the  pressure  two  pounds  daily  until  thirty  pounds  is  reached. 
As  soon  as  the  patient  has  reached  this  point,  give  the  following  vig- 
orous treatment :  Electric  light  bath  or  hot  air  to  profuse  perspiration ; 
circular  rain  bath,  105°  F.,  pressure  twenty  pounds,  for  one  minute; 
Scottish  jet  douche  to  the  colon  and  abdominal  wall,  alternating  be- 
tween 108°  and  70°  F.,  five  and  fifteen  seconds  each,  under  a  pressure 
of  ten  to  fifteen  pounds  for  one  minute.  Increase  the  hot  water  a 
degree  daily  until  115°  F.  is  reached;  decrease  the  cold  water  one 
degree  daily  to  60°  F.,  increase  the  pressure  one  to  two  pounds 
daily  until  twenty-five  to  thirty  pounds  is  registered.  Finish  the 
treatment  with  the  fan  douche  all  over  the  body  at  60°  F.  for  ten 
to  fifteen  seconds.  Care  should  be  taken  in  administering  the  douches 
to  always  extend  them  so  as  to  cover  the  region  of  the  liver.  It  will 
be  noticed  that  the  application  of  a  jet  of  very  cold  or  very  hot  water 
to  the  abdomen   causes  instant  and  vigorous  contraction  of  the  ab- 


DISEASES  OF  STOMACH  AND  INTESTINES.         249 

dominal  muscles  and  excites  intestinal  peristalsis.  In  spastic  condi- 
tions of  the  intestine  dependent  largely  upon  nervous  manifestations, 
it  will  be  found  best  to  avoid  for  a  time  the  application  of  the  cold 
douche  to  the  abdominal  wall,  and  simply  use  the  hot.  In  certain 
cases  of  anemia,  especially  in  women,  it  will  be  found  advantageous 
to  utilize  the  following  measure:  Sitz  bath  at  80°  F.  for  two  to  three 
minutes,  followed  by  the  fan  douche  to  the  abdomen,  70°  I'.,  twenty 
pounds  pressure,  for  one-half  minute.  Reduce  the  temperature  of 
the  sitz  bath  and  douche  two  degrees  daily  until  60°  F.  is  reached. 
The  perineal  douche  applied  to  the  perineum  and  anal  region  will  often 
stimulate  immediate  peristaltic  action  when  used  at  60°  F.  for  one 
to  three  minutes. 

As  previously  stated,  the  use  of  enemas  is  to  be  avoided,  but  if 
they  have  to  be  used  it  is  preferable  to  use  the  normal  saline  solutions, 
warmed,  finishing  with  a  temperature  of  70°  to  65°   F. 

In  old  cases  of  constipation  accompanied  by  gastric  derangements 
it  has  been  often  noted  that  lavage  will  produce  activity  of  the  intes- 
tine, and  in  this  way  overcome  the  associated  bowel  condition,  as 
well  as  cleansing  the  stomach.  Some  foreign  writers  use  lavage  as 
a  hydrotherapeutic  measure  in  the  treatment  of  constipation.  All 
rectal   diseases  must  be  corrected,  such  as  hemorrhoids,  fissure,  etc. 

As  associated  measures  of  great  value,  the  local  application  of  the 
static  wave  current,  especially  in  those  cases  where  gastro-intestinal 
catarrh  is  present;  the  galvanic  current,  applied  over  the  abdomen 
and  lower  spine,  or,  what  is  better,  the  slowly-interrupted  sinusoidal 
current  to  the  musculature  of  intestine  and  abdominal  wall.  In  the 
writer's  opinion,  the  least  harmful  laxative  is  cascara  sagrada. 

Neuroses  of  the  Stomach  and  Intestines. 

Under  the  above  title  we  will  consider  a  large  number  of  affec- 
tions having  as  their  origin  disorders  of  the  motor,  sensory  and  se- 
cretory functions  of  the  stomach  and  intestines,  which  are  consid- 
ered together  for  brevity's  sake  and  because  they  have,  as  a  rule, 
to  be  treated  by  the  same  general  methods.  The  treatment  of  the  vari- 
ous disorders  enumerated  is  similar,  but  it  must  not  be  supposed  that 
it  consists  of  fixed,  cut-and-dried  plans  that  should  not  be  modified. 
When  we  deal  with  the  nervous,  neurotic,  neurasthenic,  hysteric  and 
others  of  this  type  we  have  to  consider  each  case  as  an  entity,  and 
this  applies  with  full  force  to  those  nervous  affections  in  which  the 
hollow  viscera  of  the  stomach  and  bowel  are  involved.  Many  of 
them  are  minor  ailments  that  cause  the  sufferer  much  discomfort, 
but  should  none  the  less  receive  our  careful  consideration.  These 
have  no  known  anatomic  basis.  Some  have  been  considered  under 
"States  of  Hypersecretion"  and  "'States  of  Hyposecretion." 

Gastralgia,  or  true  neuralgia  of  the  stomach,  has  been  in  my  ex- 


250  PRACTICAL  HYDROTHERAPY. 

perience  a  rather  rare  affection.  An  analysis  should  always  be  made 
to  ascertain  as  to  whether  hyperchlorhydria  exists ;  diagnose  by  ex- 
clusion. 

Gastric  hyperesthesia  is,  as  Rugel  says,  "a  morbidly  increased  sen- 
sibility of  the  sensory  nerves  of  the  stomach."  This  occurs  nearly 
always  after  eating,  thus  differentiating  the  pain  from  that  of  gas- 
tralgia.  I  have  seen  several  cases,  and  all  were  in  markedly  neuras- 
thenic persons.  The  chemic  and  other  findings  are  never  in  propor- 
tion to  the  tenderness.  In  the  same  line  are  the  peculiar  sensations  of 
"sinking  at  the  stomach,"  heat  and  cold,  etc. 

The  derangements  of  appetite,  anorexia,  a  loss  of  the  desire  for 
food;  hyperkoria,  an  early  sensation  of  satisfaction  or  satiety;  bou- 
limia,  an  exaggerated  or  insatiable  desire  for  food ;  akoria,  a  lack  of 
the  normal  feeling  of  satiety;  polyphagia,  the  eating  of  too  much; 
parorexia,  or  altered  appetite,  will  often  be  found  to  be  accompanied 
by  depressed  nervous  and  psychic  states,  the  treatment  of  which  will 
be  the  guide.  Some  of  these  conditions  may  continue  until  life  itself 
is  at  stake.     These  cases  need  institutional  treatment  and  care. 

The  motor  neuroses  of  the  stomach  are  affections  brought  about  by 
varying  actions  of  the  muscular  apparatus  of  the  organ.  Gastro- 
spasm,  a  spasm  or  cramp  of  the  entire  stomach;  cardiospasm,  a  cramp 
of  the  muscles  of  the  cardiac  orifice ;  pylorospasm,  a  cramp  of  the 
pylorus ;  hyper  peristal  sis,  or  peristaltic  unrest,  an  increase  of  the 
rhythmic  contractions  of  the  stomach  of  which  the  patient  is  aware. 

Reflex  and  nervous  vomiting  arise  from  some  cause  or  irritant 
in  other  organs  or  distant  parts  of  the  body,  particularly  the  genital 
organs,  the  eye,  pharynx,  and  in  rare  cases  diseases  of  the  nose.  The 
vomiting  is  usually  painless,  produces  little  depression,  and  the  pa- 
tients enjey  fairly  good  health.  Psychic  disturbances  easily  provoke. 
In  this  class  we  may  mention  the  "periodic  or  cyclic  vomiting  of  chil- 
dren" and  the  periodic  vomiting  of  adults. 

Rumination,  merycism,  or  "chewing  the  cud,"  is  the  raising  of  the 
food  without  nausea,  remasticating  and  then  swallowing.  This  oc- 
curs normally  in  the  cow.  Regurgitation  is  a  similar  habit,  except  that 
the  food  is  rejected.     It  has  been  known  to  occur  from  imitation. 

Enteral gia  is  a  rare  neuralgia  of  the  intestines.  Closely  simulating 
it,  and  very  difficult  of  differentiation,  is  intestinal  colic,  a  cramp  or 
pain  of  intense  character  located  in  the  intestines,  usually  brought 
about  by  some  irritant  in  the  bowel.  Gaseous  distension  is  usually 
present.  Mctcorism,  tympanites,  are  gaseous  distensions  of  the  bowel, 
the  former  localized,  the  latter  diffuse.  Peristaltic  unrest  consists  of 
increased  peristaltic  movements,  and  is  more  common  than  the  gastric. 

A  careful  study  of  each  case  must  be  made,  including  a  quantita- 
tive analysis  of  the  gastric  contents,  after  which  hygienic  laws  appli- 
cable to  the  case  must  be  outlined.     The  treatment  should  be  based 


DISEASES  OF  STOMACH  AND  INTESTINES.         251 

upon  attention  to  the  local  condition,  while  at  the  same  time  general 
tonic  and  roborant  methods  are  utilized  with  a  view  of  reconstructing 
the  nervous  and  general  health,  improving  assimilation,  stimulating 
metabolism  and  increasing  the  hemic  functions.  To  this  end  a  well- 
ordered  life,  with  plenty  of  sleep,  freedom  from  care  and  worries  to 
the  extent  of  a  partial  or  complete  rest-cure  may  have  to  be  instituted, 
but  it  should  be  borne  in  mind  that  each  case  is  a  law  unto  itself  and 
must  be  so  met.  The  local  treatment,  where  conditions  of  pain,  unrest 
and  discomfort  exist,  should  consist  of  the  application  of  the  hot 
fomentation  for  fifteen  or  twenty  minutes,  followed  by  the  abdominal 
compress  for  an  hour.  This  may  be  repeated  as  frequently  as  every 
thirty  to  sixty  minutes,  and  the  writer  has  seen  attacks  of  gastralgia 
promptly  relieved  by  its  application.  Sometimes  the  drinking  of  very 
hot  water  or  the  use  of  a  very  hot  high  saline  enema  will  promptly 
check  the  condition.  Variations  in  secretions,  loss  and  change  of 
appetite,  can  be  satisfactorily  influenced  by  the  application  of  the  ice- 
bag  over  the  stomach  for  an  hour  before  meals.  Lavage  with  alternate 
hot  and  cold  water  will  exercise  the  same  toning  influence  as  that  of 
the  Scottish  douche  to  the  external  surface.  We  must,  however, 
look  to  general  treatment  for  a  radical  relief  of  these  conditions. 
Where  one  has  no  access  to  institutional  treatment  we  may  employ  the 
full  dry  pack  for  thirty  to  sixty  minutes,  followed  by  the  dripping 
sheet  at  a  temperature  of  70°  F.  for  three  minutes,  reducing  the  tem- 
perature two  degrees  daily  until  60°  F.  is  reached.  In  institutions 
the  hot-air  bath  or  the  incandescent  electric  light  bath  is  preferred  to 
the  pack,  and  once  having  established  the  patient's  reactive  capacity 
we  may  give  him  the  electric  light  bath  to  the  point  of  free  perspira- 
tion, followed  by  the  horizontal  or  circular  rain  bath  at  105°  for  one 
or  two  minutes.  Follow  this  with  the  fan  douche  to  the  entire  body 
for  one-fourth  minute  and  the  jet  douche  to  the  spine  for  one-fourth 
minute  at  70°  F.,  under  a  pressure  of  twenty  pounds ;  reduce  the  tem- 
perature two  degrees  daily  to  60°  F.  and  increase  the  pressure  two 
pounds  daily  until  thirty  pounds  is  registered.  We  may  now  proceed 
to  a  strong  and  stimulating  measure  needed  by  these  cases.  The  elec- 
tric light  bath  is  given  until  free  perspiration  takes  place ;  then  the 
horizontal  or  circular  rain  bath  at  100°  to  105°  F.  for  one  and  one- 
half  minutes;  the  fan  douche  to  the  entire  body  one- fourth  minute; 
the  jet  douche  to  the  abdominal  wall  ten  seconds;  jet  douche  to  the 
spine  for  one-fourth  minute.  Commence  these  douches  at  a  tem- 
perature of  70°  F.,  fifteen  pounds  pressure ;  reduce  temperature  one 
degree  daily  to  60°  F.,  or  even  50°  F.  where  the  patient  reacts  well ; 
increase  the  pressure  two  pounds  daily  until  twenty-five  to  thirty 
pounds  is  registered. 

These   cases   are   helped   by   a   sojourn   at  the   seashore   and   surf 
bathing.     This  is  especially  beneficial  as  a  "finishing"  treatment,  tend- 


252  PRACTICAL  HYDROTHERAPY. 

ing  as  it  does  to  give  the  patient  a  further  rest  from  the  cares  and 
anxieties  of  life  under  most  favorable  and  hygienic  conditions. 

Certain  associated  treatments  are  of  unquestioned  value,  espe- 
cially the  use  of  galvanism  applied  over  the  abdomen  and  up  and 
down  the  spine ;  the  static  wave  current  will  oftentimes  materially  aid 
in  relieving  the  local  condition ;  so  will  mechanical  massage,  and  vibra- 
tion and  manual  massage  applied  to  the  abdomen  and  general  system. 


CHAPTER  XIII. 

DISEASES  OF  THE   NASO-PHARYNX,  LARYNX  AND   CHEST. 

Acute  Rhinitis;  Acute  Pharyngitis;  Acute  Tonsillitis;  Acute  Laryn- 
gitis; and  the  Treatment  of  Post-Operative  Inflammations. 

Acute  colds  and  acute  sore  throats  are  embraced  under  the  above 
general  heading.     They  are  acute  catarrhal  inflammations  of  the  mu- 
cous membrane  of  the  nose,  tonsils,  uvula,  soft  palate,  pharynx  and 
larynx,  being  generally  characterized  by  fever,  painful  deglutition,  free 
discharge,  coughing  and  a  desire  to  clear  the  throat.     The  discharges 
are.  as  a  rule,  fluid,  watery  or  mucous,  very  free  in  quantity.     They 
have   their   most    frequent   origin    in    atmospheric   changes,    especially 
those  due    to  exposure  of  the  head  and  neck  to  draughts  of  cold  air. 
A   favorite  method  of  acquisition  is  riding  in  street-cars  while  per- 
spiring, or  the  practice  of  wearing  thin  soles  and  stockings  and  sub- 
jecting the   feet  to  cold  and   dampness.     This  is  especially   frequent 
with  women.     They  sometimes  arise  from  irritant  vapors,  dust,  etc. 
In  the  treatment  of  these  acute  conditions,  where  the  condition  is  not 
severe,  it  will  be  sufficient  to  simply  diminish  the  quantity  of   food 
eaten,  give  rest  to  the  throat  and  nose,  spray  them  with  antiseptics. 
open   the  bowels    freely,   and   drink   largely  of  carbonated   water,   an 
excellent  example  of  which  is  equal  parts  of  plain  and  Vichy  water. 
If   the   case   is   severe    it   may   become   necessary    for   the   patient  to 
be  put  to  bed.     In  any  event  general  and  local  measures  should  be 
adopted.     Where  one  has  no  accesss  to  institutional  treatment  an  ex- 
cellent measure  is  the  use  of  the  hot  full  bath,  commencing  at  a  tem- 
perature of  100°  F.  and  rapidly  increasing  to  108°  or  110°  F.,  if  pos- 
sible.     This   should  be    followed   by   a   very  brief   cold   application— 
that  is  to  say.  a  shower  or  cold  sponge  at  a  temperature  of  70°  to  60° 
F.     This  treatment  is  best  given  just  before  retiring,  and  after  its  ad- 
ministration the  patient  should  be  at  once  removed  to  bed,  carefully 
covered  and  given  a  very  hot  foot-bath  at  110°  to  115°   F.   tor  ten 
minutes.     There  is  no  known  home  method  with  which  I  am  familiar 
that   will   so   surely   abort   these   acute   inflammations   as   the   method 
above  suggested.     Where  this  is  not  accessible  we  may  employ  the  full 
dry  pack  for  thirty  minutes,  or  the  full  wet  pack  for  one  hour,  fol- 
lowed by  the  cold 'sponge  at  60°   F.  and  the  hot  foot-bath  at  110°  to 
115°   F.'for  ten  minutes.     An  excellent  measure  to  relieve  and  abort 
the   early  stage  of  these  inflammations   is  the  Turkish  bath,  accom- 
(253) 


254  PRACTICAL  HYDROTHERAPY. 

panied  by  free  water-drinking.  In  sanatoria  we  employ  the  hot-air 
bath,  electric  light  bath  or  superheated  dry  hot  air  to  free  perspira- 
tion, continued  for  several  minutes,  followed  by  the  circular  or  hori- 
zontal rain  bath  at  104°  for  one  minute  under  pressure  of  thirty 
pounds,  reduced  to  65°  F.  for  one-third  minute.  With  vigorous 
persons  this  may  be  followed  by  the  use  of  the  jet  douche  to  the 
spine   for  ten  seconds  at  60°   F. 

Local  measures  serve  to  relieve  a  great  deal  of  the  discomfort 
and  hasten  recovery.  We  may  employ  hot  alkaline  gargles,  such  as 
the  normal  salt  solution,  Seller's  solution  or  antiseptic  steam  inhala- 
tions. Another  excellent  method  is  the  fomentation  to  the  face  and 
neck  every  three  hours,  followed  by  the  cold  throat  compress  between 
times,  or,  what  is  better,  the  author's  throat  compress.  Where  the 
inflammation  is  very  severe  a  partially  filled  ice-bag  may  be  applied 
over  the  throat  compress. 

Chronic     Rhinitis;      Chronic     Pharyngitis;      "Clergyman's     Sore 
Throat";     Chronic  Tonsillitis;     Chronic     Laryngitis. 

These  are  chronic  inflammations  of  the  mucous  membrane  lining 
the  nose,  pharynx,  tonsil  and  larynx,  which  are  characterized  by  a 
sensation  of  fullness,  discomfort,  increased  secretion  and  perversion 
of  the  senses  of  smell  and  hearing  and  a  change  in  the  character  of 
the  voice.  It  most  frequently  results  from  repeated  attacks  of  acute 
inflammation  or  from  general  depraved  states.  Certain  preliminary 
measures  are  necessary  for  the  successful  treatment  of  these  condi- 
tions. Where  there  are  any  hypertrophies,  vegetations,  enlarged 
tonsils,  etc.,  these  should  be  removed  or  corrected  and  at  the  same 
time  local  applications  of  nitrate  of  silver,  picratol,  argyrol  or  other 
medicinal  measures  utilized.  Care  must  be  taken  to  prevent  acute 
attacks,  and  should  they  occur  must  be  immediately  treated.  It  has 
been  the  writer's  experience  that  one  of  the  most  potent  causes  in 
these  most  troublesome  affections  has  been  the  common  and  prevalent 
habit  of  mouth-breathing,  which  can  at  the  present  day  be  most 
certainly  and  surely  overcome  by  means  of  simple  mechanical  devices 
which  compel  breathing  through  the  normal  channels.  Especial  care 
should  be  taken  to  secure  proper  digestion  and  elimination.  Wrhere 
we  can  build  up  the  general  health,  secure  plenty  of  open-air  exercise 
or  the  use  of  gymnastics,  we  can  frequently  train  the  body  to  stand 
the  exposures  that  would  under  ordinary  circumstances  produce  severe 
acute  attacks  or  gravely  aggravate  chronic  conditions.  To  secure  this 
desideratum  it  is  essential  that  the  activity  of  the  skin  be  maintained 
at  the  highest,  and  that  at  the  same  time  the  cutaneous  circulation 
must  possess  a  tone  that  is  not  easily  influenced  by  changes  in  tem- 
perature. Chronic  inflammations  of  the  upper  respiratory  passages 
are  best  met  by  measures  general  and  local.     At  home  we  may  pre- 


NASO-PHARYNX,  LARYNX  AND  CHEST.  255 

scribe  the  use  of  the  hot  full  bath  at  102°  to  105°  F.  for  ten  minutes, 
followed  by  the  shower  bath  at  80°  F.  for  one-half  minute,  reducing 
same  two  degrees  daily  until  60°  F.  is  reached,  followed  by  the  hot 
foot-bath  at  110°  to  115°  F.  for  ten  minutes.  To  enhance  and  retain 
the  circulation  actively  in  the  feet,  the  foot-bath  should  be  followed 
by  a  douche  of  cold  water  over  the  feet.  This  treatment  is  best  taken 
at  bedtime  every  other  night,  the  intervening  nights  being  devoted 
to  the  use  of  the  oil  rub.  Where  such  a  treatment  is  inaccessible  we 
may  employ  the  full  wet  pack  at  65°  F.  for  one  hour,  followed  by  the 
cold  half  bath  at  70°  F.  for  three  minutes,  using  vigorous  friction. 
Reduce  temperature  of  pack  and  half  bath  one  degree  daily  until 
60°  F.  is  reached.  In  institutions  the  most  satisfactory  method  is 
the  following:  The  hot-air  bath,  superheated  dry  hot  air,  and,  what 
is  probably  the  best,  the  electric  light  bath  until  profuse  perspiration. 
Follow  this  treatment  by  the  horizontal  or  circular  rain  bath  at  a 
temperature  of  100°  to  102°  F.  for  one  minute,  reduced  to  70°  F.  for 
one-fourth  minute,  twenty  pounds  pressure.  Reduce  temperature  one 
degree  and  increase  pressure  one  pound  daily  until  a  temperature  of 
60°  F.  and  a  pressure  of  thirty  pounds  are  registered.  As  soon  as  the 
patient  responds  well  we  may  add  to  the  electric  light  bath  the  follow- 
ing treatment:  Horizontal  rain  bath  to  body  for  one- fourth  minute; 
the  jet  douche  to  the  spine  one-fourth  minute,  especial  care  being 
taken  to  apply  thoroughly  to  the  cervical  region.  Each  one  of  these 
methods  should  be  followed  by  the  cold  foot-bath  at  60°  to  50°  F.  for 
one-fourth  to  one-half  minute.  Patients  suffering  from  these  chronic 
inflammatory  troubles  secure  great  benefit  and  help,  oftentimes  a 
permanent  cure,  from  a  sojourn  at  the  seashore  for  several  months, 
where  they  can  utilize  all  the  advantages  that  arise  from  freedom 
from  business  and  affairs,  pleasant  recreation  and  surf  bathing.  Xot 
only  do  we  have  the  advantage  in  these  cases  of  the  percussory  in- 
fluence of  the  cold  and  agitated  sea  water  upon  the  skin  surface,  but 
the  cleansing  and  healing  influence  of  the  strong  saline  that  inad- 
vertently enters  the  nose,  mouth  and  throat. 

Local  measures  are  most  valuable.  The  hot  compress  as  hot  as 
can  be  borne  applied  to  the  face,  over  the  nose,  around  the  throat 
and  to  the  cervical  spine,  followed  by  the  cold  compress  at  60°  F. 
applied  to  the  same  regions.  In  addition  to  this  treatment,  the  stim- 
ulating throat  compress  should  be  worn  during  the  night.  Much 
relief  will  be  derived  from  a  thorough  cleansing  of  the  nose  and 
throat  with  alkaline  sprays,  followed  by  those  containing  menthol, 
camphor  and  the  essential  oils  dissolved  in  alboline. 

Croupous  Laryngitis. 

True  or  membranous  croup  is  an  acute  inflammation  of  the  mucous 
membrane    of   the   larynx   attended    with   the    exudation   of   a   tough 


256  PRACTICAL  HYDROTHERAPY. 

secretion  or  false  membrane,  the  occurrence  of  spasm  of  the  glottis, 
and  characterized  by  febrile  reaction,  frequent  peculiar  cough, 
dyspnea  and  a  tendency  toward  death  by  asphyxia.  The  affection  is 
very  fatal,  and  the  danger  is  great  in  proportion  to  the  age  and 
feebleness  of  the  patient.  Hydrotherapy  may  contribute  slightly 
toward  relieving  the  symptoms.  The  hot  full  bath  at  102°  to  105°  F., 
with  a  cold  compress  to  the  head,  followed  by  a  cold  compress  at 
60°  F.  applied  over  the  larynx  and  changed  every  half  hour,  will 
frequently  prove  of  service.  No  practitioner  should  fail  to  admin- 
ister, when  in  doubt,  the  diphtheritic  antitoxin,  and  to  have  readily 
accessible  every  means   for  prompt  intubation. 

Spasmodic  Laryngitis;  Laryngismus  Stridulus. 

False  or  catarrhal  croup  is  a  catarrhal  inflammation  of  the  mucous 
membrane  of  the  larynx,  associated  with  temporary  spasmodic  closure 
of  the  glottis,  characterized  by  paroxysmal  coughing,  difficulty  of 
breathing  and  attacks  of  threatened  suffocation.  Laryngismus  strid- 
ulus is  a  spasm  of  the  muscles  of  the  larynx,  characterized  by  sudden 
dyspnea  and  deficient  oxygenation  of  the  blood.  These  require  one 
and  the  same  treatment,  and  will  be  therefore  considered  together. 
The  attacks  occur  most  frequently  in  children.  The  preventive  treat- 
ment of  these  conditions  should  have  for  its  object  the  removal  of  all 
enlarged  tonsils,  adenoids  and  nasal  obstructions  of  every  kind. 
During  the  paroxysm  the  child  should  be  at  once  placed  in  a  hot  full 
bath  and  at  the  same  time  a  cold  compress  at  60°  to  50°  F.  applied 
over  the  larynx.  This  may  be  used  in  conjunction  with  spraying  of 
the  throat  with  a  2  per  cent,  aqueous  solution  of  cocaine.  As  soon 
as  the  paroxysm  is  relieved  the  patient  may  be  removed  to  bed  and  a 
cold  throat  compress  at  50°  to  40°  F.  applied  to  the  neck.  This 
should  be  removed  at  the  end  of  every  three  hours,  at  which  time  a 
hot  fomentation  may  be  then  applied  for  one-half  to  one  minute  over 
the  larynx  and  two  to  three  minutes  over  the  cervical  spine,  followed 
again  by  the  cold  throat  compress.  Kellogg  suggests  that  during  the 
spasm  or  paroxysm  the  chest  be  percussed  with  the  wet  end  of 
a  cold  towel  o  cold  water  be  dashed  over  the  chest.  During  the  inter- 
paroxysmal  period  steam  inhalations,  to  which  some  creosote  has  been 
added,  will  often  prove  comforting  and  satisfactory.  As  soon  as 
improvement  takes  place  we  must  reconstruct  the  general  health  and 
prevent  attacks  by  hardening  the  skin  by  the  use  of  daily  cold  tonic 
measures.  Even  infants  can  be  gradually  and  systematically  trained 
to  stand  cold  water,  but  it  takes  patience,  firmness  and  insistence  on 
the  part  of  the  attending  physician  to  overcome  the  unfounded  fear 
of  the  laitv  of  cold  water. 


NASO-PHARYNX,  LARYNX  AND  CHEST.  257 

Acute  Bronchitis;  Capillary  Bronchitis. 

Acute  bronchial  catarrh  is  an  acute  catarrhal  inflammation  of  the 
bronchial  tubes,  characterized  by  fever,  pain  and  constriction  of  the 
chest,  oppression  in  breathing  and  a  more  or  less  profuse  expectora- 
tion. It  is  found  frequently  in  children  and  in  the  aged  and  in  those 
who  are  exposed  to  an  atmosphere  that  is  cold  and  damp.  It  occurs 
especially  after  measles  and  influenza,  its  exciting  cause  being  micro- 
organisms ;  many  staphylococci  and  streptococci  arc  found  in  the 
sputum.  \s  a  rule  its  mortality  is  small,  only  very  aged  and  feeble 
persons  succumbing.  The  patient  should  be,  as  a  rule,  confined  to  a 
,  well-ventilated  warm  room,  and  if  feeble  placed  in  bed;  restricted 
soft  or  liquid  diet  may  be  prescribed  and  calomel  administered.  The 
first  aim  should  be  the  securing  of  free  skin  action,  as  this  will 
relieve  the  visceral  congestion  and  eliminate  toxins.  In  practice  we 
may  employ  the  following  procedure :  Allow  the  patient  to  sip  a  glass 
of  very  hot  water,  after  which  we  may  use  either  the  full  dry  pack 
for  thirty  minutes,  the  wet  sheet  pack  at  70°  F.  for  one  hour,  or  a  hot 
full  bath  at  104°  to  105°  F.  for  ten  minutes,  in  each  instance  re- 
moving the  patient  to  bed  and  following  with  the  cold  sponge  at  60° 
F.,  or  the  dripping  sheet  at  70°  for  three  minutes.  This  treatment 
may  be  repeated  once  or  twice  daily  if  necessary,  though  the  latter 
is  not  suggested.  Where  we  have  to  deal  with  an  irritable,  tenacious 
and  weakening  cough  it  will  be  found  advantageous  to  allow  the 
patient  to  sip  and  gargle  the  throat  with  very  hot  water  or  inhale 
steam.  Much  benefit  will  be  derived  from  the  use  of  the  chest  com- 
press in  addition  to  the  above  measures.  There  is  no  question  but 
what  many  cases  of  acute  bronchitis  could  be  greatly  modified,  cut 
short  or  even  aborted  by  having  recourse  at  its  immediate  commence- 
ment to  the  Turkish  bath.  In  institutional  treatment  we  find  the 
electric  light  bath  to  the  point  of  profuse  perspiration,  followed  by 
the  dripping  sheet  at  70°  to  60°  F.  for  three  minutes,  or  the  horizon- 
tal or  circular  rain  bath,  70°  to  60°  F.,  for  one-fourth  minute,  most 
useful.  The  author  has,  however,  allowed  superheated  dry  hot  air 
to  supersede  the  other  methods.  The  patient  is  placed  in  the  body 
apparatus  for  twenty  to  forty  minutes  at  temperatures  ranging  from 
250°  to  300°  F.,  especial  care  being  taken  to  place  a  cold  compress 
or  ice-bag  upon  the  head.  The  patient  is  removed  from  the  apparatus 
and  allowed  to  perspire  in  a  blanket  pack  for  ten  or  fifteen  minutes, 
after  which  the  horizontal  or  circular  rain  bath  at  70°  F.  for  twenty 
seconds  is  then  administered.  In  my  hands  nothing  has  equalled  these 
measures  in  the  prevention  and  cure  of  bronchial  affections. 

What  has  been  said  of  acute  bronchitis  is  equally  applicable  to 
capillary  bronchitis,  an  acute  catarrhal  inflammation  of  the  mucous 
membrane   of   the   bronchioles,   and   characterized  by   fever,   impeded 


258  PRACTICAL  HYDROTHERAPY. 

respiration,  slight  cough  and  scanty  expectoration.  Huebner1  has 
suggested  the  following  plan  of  treatment  in  the  suffocative  stage  of 
this  disease  in  children :  Half  a  kilo  of  fresh  mustard  flour  is  thor- 
oughly stirred  into  one  and  one-half  litres  of  warm  water  until  the 
fumes  arising  from  the  mixture  become  irritating  to  the  eyes.  This 
requires  about  ten  minutes.  A  sheet  sufficiently  large  to  envelop  the 
child  is  then  saturated  in  this  mixture,  wrung  out  and  spread  on  a 
blanket.  On  this  the  child  is  placed  naked,  then  closely  covered  by 
the  sheet  from  the  feet  to  the  neck,  the  blanket  being  brought  over 
all,  so  that  a  moist  mustard  full  pack  is  the  result.  In  this  the  child 
should  remain  from  ten  to  fifteen  minutes,  until  it  shows  by  its  rest- 
lessness that  the  irritation  of  the  skin  is  becoming  pronounced.  It 
is  then  quickly  removed  from  the  pack,  washed  in  plain  warm  water 
to  remove  all  trace  of  mustard,  and  then  placed  in  a  warm  pack  made 
by  wringing  a  sheet  out  of  plain  water,  and  covered  by  a  blanket 
In  this  pack  the  child  should  be  left  for  one  or  two  hours,  the  length 
of  time  being  controlled  by  the  temperature  of  the  child,  which  is 
likely  to  increase.  When  this  occurs,  or  when  a  very  profuse  perspi- 
ration appears,  the  child  should  be  removed,  again  bathed  in  plain 
warm  water,  then  dried,  clothed  in  an  ordinary  gown  and  returned 
to  bed.  where  it  should  be  left  undisturbed.  The  procedure  should 
not  be  repeated  within  twenty- four  hours,  but  in  severe  or  prolonged 
cases  may  be  employed  daily  for  three  or  four  days.  Though  more 
tedious,  it  is  applicable  under  a  greater  variety  of  circumstances  than 
the  hot  mustard  bath,  and,  as  it  is  better  borne,  allows  time  for  a 
more  pronounced  effect. 

Chronic  Bronchitis;  Fibrinous  Bronchitis. 

Chronic  bronchial  catarrh  is  a  chronic  inflammation  of  the  mu- 
cous membrane  of  the  larger  and  middle-sized  bronchial  tubes,  char- 
acterized by  cough  and  more  or  less  profuse  expectoration,  usually 
following  a  succes-ion  of  acute  attacks.  It  is  common  in  the  aged, 
accompanies  the  infections,  and  may  arise  indirectly  from  gout,  alco- 
hol rheumatism  or  syphilis.  It  is  frequently  associated  with  chronic 
gastric  catarrh.  The  treatment  of  this  condition  should  bear  in  mind 
the  causal  relations  above  mentioned,  the  treatment  of  which  will  be 
found  under  their  respective  headings.  In  all  cases  an  equable  tem- 
perature of  the  chest  should  be  secured,  the  best  garments  to  be  worn 
being  woolen  ones  of  medium  weight.  Care  should  be  exercised  not 
to  dress  too  heavily,  owing  to  the  fact  that  upon  entering  warm  rooms 
slight  perspiration  is  apt  to  take  place,  which  would  be  followed  by 
chilling  upon  entering  the  external  colder  air.  Draughts,  especially 
damp,  cold  weather,  wet  feet  and  overexertion  must  be  guarded 
against.     The  writer  has  had  an  extended  experience  in  the  treatment 

1  Therapie  der  Gegenwart,  1905,  p.   1. 


NASO-PHARYNX,  LARYNX  AND  CHEST.  2W 

of  chronic  bronchitis,  and  believes  that   the  basis  of  restoration  of 

the  bronchial   tubes   is   the   restoration   of  the  normal   general   tone, 
while  at  the  same  time  we  lessen  the  local     inflammation.    1  he  aim 
should  then  be  to  remove  all  causal  factors,  at  the  same  time  reducing: 
the  local  inflammation  and  building  up  the  general  health.     There  is 
no  question  but  what  the  administration  of  alkaline  waters  in  consid- 
erable volume  is  of  great  benefit  to  those  afflicted  with  this  disease. 
Many  suggest  the  use  of  water  of  alkaline  mineral  springs,  but  the 
writer  has  found  the  ordinary  alkalies,  well  diluted,  to  be  just  as  valu- 
able as  the  much-vaunted  waters.     The  diet  should  be  reconstructive, 
and  contain   a  large  quantity  of   fats,  butter,  milk,  cream,  olive  oil 
mayonnaise   dressing  and  other   foods  of  a   similar  nature.     The  oil 
rub  at  night,  used  in  conjunction   with  hydrotherapy,  is  a  valuable 
measure.     Care  should  be  taken  to  correct  nasal,  tonsillar  and  pharyn- 
geal troubles,  as  these  are  weak  spots  tending  to  accentuate  and  per- 
petuate the  bronchial  condition.     These  cases  should  be  taught  respira- 
tory gymnastics,  especial  benefit  being  derived  from  the  outward  and 
inward  movements  of  the  arms.     It  is  my  custom  to  suggest  deep 
inhalations  half  a  dozen  times  during  the  day.     Much  good  can  fre- 
quently  be    derived    from    the    correction    of    mouth   breathing,    thus 
preventing  the  irritating  effects  of  improperly  heated  and  moistened 
air  entering  the  bronchial  tubes.     As  chronic  bronchitis  occurs  more 
often  in  the  aged,  it  is  well  to  commence  with  very  mild  measures, 
carefullv   securing   reaction   in   each   instance.      The   writer   generally 
commences  with  the  use  of  the  electric  light  bath  until  the  patient 
is  warm,  after  which  there  is  administered  a  salt  rub,   followed  by 
a  rapid  cold  sponge,  the  temperature  of  the  water  being  at  80°   F. ; 
reduce  the  temperature  two  degrees  daily  to  70°   F.     We  may  now 
proceed  to  the  use  of  the  following  method:  Electric  light  bath,  hot 
air  or  dry  pack  until  perspiration  just  commences,  then  the  dripping 
sheet  at  70°  F.  for  three  minutes,  accompanied  by  vigorous  friction. 
Rub  well  afterward  with  a  crash  towel  until  reaction  is  secured. 

In  some  cases  this  is  followed  by  a  rapid  oil  rub.  This  treatment 
should  be  repeated  daily,  reducing  one  degree  each  treatment  until  60° 
F.  is  reached,  at  which  time  we  may  move  up  another  step,  as  follows: 
The  electric  light  bath  or  hot  air  until  commencing  perspiration,  fol- 
lowed by  the  horizontal  or  circular  rain  bath  at  100°  to  104°  F.  for 
one  to  one  and  one-half  minutes,  twenty  pounds  pressure;  reduce  to 
70°  F.  for  one-third  minute.  Reduce  the  temperature  one  degree 
daily  until  60°  F.  is  reached  and  increase  the  pressure  one  pound  until 
thirtv  pounds  is  registered  on  the  gauge.  These  cases  are  always 
best 'treated  in  sanatoria.  It  is  astonishing  to  notice,  where  the  treat- 
ment is  carried  out  carefullv,  thoughtfully  and  painstakingly,  how 
the  skin  of  these  individuals  will  lose  its  gray,  greasy,  leathery  look, 
assume  a  softer  and  better  character;  how  the  color  will  come  to  the 


260  PRACTICAL  HYDROTHERAPY. 

surface ;  how  the  irritating  and  hacking  cough  will  lessen  ;  how  ex- 
pectoration will  become  freer  and  finally  cease ;  how  the  appetite, 
digestion  and  elimination  pick  up.  It  is  a  metamorphosis  not  as 
rapid,  but  as  pleasing,  as  those  that  arose  from  the  magic  influence 
of  Aladdin's  lamp. 

Pulmonary  Congestion. 

Pulmonary  engorgement,  hypostatic  congestion,  is  an  increase  or 
abnormal  fullness  of  the  capillaries  surrounding  the  air  cells ;  active 
when  the  result  of  accelerated  circulation  and  passive  when  caused 
by  an  impeded  outflow  from  these  vessels.  Active  congestion  of  the 
lung  most  often  occurs  from  prolonged  exposure  to  cold,  over-exer- 
tion or  the  inhalation  of  cold  or  hot  air.  The  writer  has  seen  two 
cases  due  to  prolonged  swimming  in  cold  water.  The  passive  arises 
in  those  obstructed  conditions  in  which  we  have  to  deal  with  valvular 
disease  and  dilated  heart,  nephritis,  or  in  the  infectious  fevers.  In 
treatment  these  conditions  must  be  taken  into  consideration,  and 
where  they  act  as  causal  factors  appropriate  measures  must  be  adopted. 

In  acute  congestion  the  endeavor  should  be  made  to  withdraw  the 
blood  from  the  lung  and  cause  a  contraction  of  the  capillary  blood- 
vessels. This  is  best  accomplished  by  rest  in  bed,  with  frequent 
changes  of  position.  Administer  a  very  hot  foot-bath  (110°  to  115° 
F. )for  fifteen  to  twenty  minutes,  with  the  legs  immersed  to  the  knee. 
This  should  be  followed  by  the  hot  dry  half  pack  or  the  hot  wet  half 
pack  applied  to  the  lower  limbs  and  as  high  as  the  umbilicus.  At 
the  same  time  we  may  apply  the  cold  chest  compress,  50°  to  60°  F., 
and  repeated  as  necessary,  from  twenty  to  thirty  minutes,  or  the 
double-column  Chapman  hot-water  bag  to  the  upper  dorsal  spine. 
There  is  no  objection  to  using  the  cold  chest  compress  anteriorly  and 
the  Chapman  hot-water  bag  to  the  dorsal  spine  posteriorly. 

In  the  passive  or  hypostatic  form,  which  usually  occurs  in  febrile 
conditions  or  systemic  disease,  much  can  be  accomplished  by  frequent 
change  in  position.  Where  hydrotherapy  is  employed  in  fevers  hypo- 
static congestion  is  a  rarity.  When  conditions  of  obstructed  circula- 
tion or  nephritis  occur,  these  diseases  must  be  treated  in  order  to 
overcome  the  condition.  The  best  treatment  of  passive  congestion  of 
the  lung  is  the  application  of  the  hot  fomentation  for  ten  minutes 
to  the  entire  chest,  followed  by  the  cold  chest  compress  at  60°  F., 
renewed  every  three  hours.  Before  every  application  of  the  compress 
the  fomentation  must  be  repeated. 

Pulmonary  Edema. 

Pulmonary  edema  is  an  exudation  of  serum  into  the  pulmonary 
tissue  and  alveoli,  characterized  by  frothy,  blood-streaked  expectora- 
tion, cough  and  dyspnea.     It  is  a  grave  condition,  and  is  in  the  major- 


NASO-PHARYNX,  LARYNX  AND  CHEST.  261 

ity  of  instances  a  symptom  of  some  acute  or  chronic  disease.  For 
that  reason  remedial  measures  offer  little.  The  conditions  that  pro- 
duce the  trouble,  whether  they  be  cardiac  disease,  nephritis,  or  an 
infectious  disease,  are  the  ones  to  be  treated.  In  this  disease,  as  in 
pulmonary  congestion,  we  may  employ  the  hot  foot-bath  to  the  knee 
at  110°  to  115°  F.  for  fifteen  to  twenty  minutes,  followed  by  the  hot 
dry  half  pack,  together  with  the  cold  chest  compress  at  60°  for  twenty 
to  thirty  minutes,  repeated  as  often  as  necessary.  To  sustain  the 
heart  the  ice-bag  should  be  applied  to  the  precordium,  and  strychnia 
and  atr<  pine  injected  hypodermically.  Little  can  be  accomplished 
by  this  treatment  unless  other  measures  reaching  the  causal  condi- 
tions are  successful  in  removing  them. 

Hemoptysis — Pulmonary  Hemorrhage. 

Hemoptysis  is  the  expectoration  of  blood — in  fact,  is  a  pulmonary 
hemorrhage — which  may  arise  from  the  bronchial  tubes  or  from  the 
broncho-pulmonary  tissues.  It  is  usually  a  symptom  of  some  _  other 
disease,  generally  tuberculosis,  or  may  occur  from  other  causes,  and 
where  these  exist  the  treatment  of  the  causa!  condition  must  be  taken 
into  consideration.  Pulmonary  hemoptysis  demands,  in  the  writer's 
opinion,  an  immediate  hypodermic  injection  of  morphine  and  atropia, 
without  the  addition  of  any  other  drug,  ergot  and  its  ilk  being  value- 
less. Examine  the  nose  and  throat  for  bleeding  points,  which,  if  they 
exist,  touch  with  a  styptic.  Rest  in  bed  is  imperatively  demanded  in 
a  room  that  is  kept  cool.  The  diet  should  be  liquid  and  as  little  as  is 
consistent.  The  swallowing  of  small  pieces  of  ice  sometimes  helps, 
and  all  hot  or  warm  drinks  should  be  avoided.  If  the  hemorrhage  is 
actively  taking  place,  a  bandage  should  be  applied  to  the  legs  to  pre- 
vent, as  much  as  possible,  the  return  of  blood  toward  the  lungs,  and 
partially  arresting  the  return  flow.  A  tumbler  of  ice  water  in  which 
a  tablespoonful  of  salt  has  been  dissolved  sometimes  helps.  Apply 
ice-bag  to  the  supraclavicular  fossa  and  the  cold  chest  compress  at 
40°  to  50°  F.  for  fifteen  to  twenty  minutes,  repeating  as  often  as  is 
necessary.  The  Chapman  double-column  hot-water  bag  should  be 
applied  to  the  upper  dorsal  spine,  its  action  being  to  cause  a  contrac- 
tion of  the  blood-vessels  entering  the  lung.  When  the  hemorrhage 
has  been  checked,  care  must  be  exercised  in  the  return  to  activity  and 
in  the  adoption  of  further  measures.  It  may  be  added,  as  a  final  word, 
that  the  after-treatment  consists  in  the  management  of  the  disease, 
causing  the  hemorrhage 

Lobar  Pneumonia;  Catarrhal  Pneumonia. 

Pneumonia  is  an  acute  infectious  inflammation,  involving  the  vesic- 
ular structure  of  the  lung,  rendering  the  alveoli  impervious  to  air, 
and  characterized  by  fever,  cough,  thoracic  pain,  dyspnea,  headache. 


262  PRACTICAL  HYDROTHERAPY. 

rusty  sputum  and  great  prostration.  Its  origin  is  a  specific  organism, 
the  diplococcus  pneumoniae  of  Fraenkel.  although  mixed  infections 
occur.  The  seat  of  election  and  its  chief  effects  are  upon  the  lung,  the 
micro-organism  being  found  in  the  sputum.  It  is  a  disease  of  grave 
prognosis,  the  mortality  of  which  ranges  from  20  to  40  per  cent. 
Old  age  and  alcoholism  render  the  prognosis  bad.  In  no  acute  infec- 
tious disease  does  temperate  living  and  a  moral  life  count  for  as  much 
as  in  an  attack  of  acute  pneumonia.  One  attack  predisposes  to  another, 
as  does  exposure  and  debilitated  conditions.  The  seriousness  of  the 
disease  demands  that  we  shall,  from  the  start,  use  every  measure  that 
will  conserve  the  energy  and  strength  of  the  patient  and  at  the  same 
time  enhance  vitality.  The  patient  should  at  once  be  placed  in  a  room 
from  which  all  useless  objects  have  been  removed,  the  temperature  of 
the  room  being  maintained  at  65°  F..  with  an  abundance  of  pure 
warm  air.  The  bed  should  be  single,  protected  from  draughts,  acces- 
sible from  either  side,  the  mattress  being  protected  by  rubber  cloth 
or  sheet.  The  patient  should  be  clothed  in  a  soft  flannel  gown  opening 
its  entire  length  in  front.  The  bedclothes  must  be  light,  the  sheets 
changed  frequently,  the  expectoration  and  discharges  caught  in  vessels 
in  which  are  antiseptic  solutions  and  later  burned.  The  diet  should 
be  liquid,  using  milk,  broth,  egg  albumen-orange  solutions,  etc.  Baruch 
recommends  the  use  of  six  ounces  of  cold  water  every  two  hours, 
alternating  with  the  same  quantity  of  cold  milk,  night  and  day.  when 
the  patient  is  awake,  the  result  of  which  is  an  enormous  increase  of 
urine,  scarcely  credible,  even  as  much  as  60  to  122  ounces  in  twenty- 
four  hours.  Todd2  says  that  '"six  to  eight  ounces  of  water,  alkalinized 
by  adding  two  and  one-half  grains  of  sodium  chloride  and  ten  grains 
of  potassium  bicarbonate  to  the  ounce,  should  be  given  every  two 
hours."  If  a  teaspoonful  of  lemon  juice  is  added  it  makes  a  pleasant 
effervescent  drink.  The  author  first  learned  of  this  in  1884  from  an 
Italian  physician,  and  has  found  it  a  palatable  beverage.  There  is  no 
question  but  what  the  free  ingestion  of  cold  alkaline  water  is  of  de- 
cided benefit  to  these  cases,  in  that  it  favors  oxidation,  which  is  so 
much  needed,  and  at  the  same  time  acts  as  a  diluent  and  eliminant 
of  toxins  and  waste  products. 

Care  should  be  exercised  not  to  over-feed,  as  the  loss  of  strength 
is  due  to  poisoned  nerve  and  muscle,  and  not  to  a  lack  of  nutrition. 
It  should  further  be  borne  in  mind  that  with  the  loss  of  air.  due  to 
the  involved  lung  structures,  there  is  deficient  oxidation  in  the  body, 
and  food  is  not  utilized.  It  is  irrational  and  unphysiological  to  feed 
patients  large  quantities  of  food  they  cannot  assimilate,  and  this  is 
essentially  true  of  the  acute  infectious  diseases.  Food  is  best  admin- 
isterd  at  periods  of  every  three  hours,  care  being  taken  to  avoid  a 
distended   stomach  and  abdomen.     "If  pneumonia  be  regarded  as  a 

2  Todd.    T.    B.:     New   York   Medical  Journal.    1905. 


NAS0-PH4RVNX,  LARYNX  ANP  CHEST.  263 

constitutional  malady  with  a  local  lesion,  then  the  «"""**""( 
„„   'pre  all,  Eq,  [refitment  than  does  the  mtestroal  ulcer  of  typhoid 
fever   hut  .he  general  condition  of  the  patient  is  to  govern  in  the  man- 
agement, and  fa,  the  local  changes  in  the  thorax.'      In  all  treatment 
JETS  instituted  especial    care  should  be  taken  to  prevent  pulmonary 
e  t  ston  from  exposure  of  the  shoulders  or  chest  to  dull  by  evap- 
S«.    There  is  no  specific  treatment  for  pneumon.a,  bnt  the  patient 
must  be  carefully  and  closely  watched  and  treatment  adjus ted  to  con- 
dhions     At  the  outset  there  is  no  question  hut  what  calomel  should  h 
'  cribed  in  good  purgative  doses.  The  aim  and  object  of  the  treatment 
in  pneumonia   is  the  maintenance  of  vital  activity  untd  opportunity 
h  s'been  afforded  the  system  for  the  elimination  of  the  toxins  and  to 
development  of  antitoxins,  which  assist  in  the  suppression  of  the  dis- 
ease and  bring  about  natural  healing  processes. 

In  hospital  and  private  practice  tins  is  the  most  fatal  of  all  acute 
diseases      The  most   striking  and   important   similarity  between  th,s 
'    d  tvphoid  fever  is  that  the  chief  point  of  attack  is  upon  the  nervous 
em;  the  toxemia  resulting  from  the  life  and  death  of  the  micro- 
organisms spends  its  chief  force  upon  the  nerve  centers.     The  treat- 
men      hcrefore,  resolves  itself  into  two  lines-local  measures    which 
"  be  adopted  to  lessen  the  production  of  toxic  material  in  the  lung 
and  obviate' the  mechanical  obstacle  to  respiration,  and  general  meas- 
ures   which  should  be  directed  toward  minimizing  the  toxic  effects 
upon  the  system  by  maintaining  the  highest  vital  resistance.  Ow  ng 
Tthe  senshiveness  of  the  pneumococcus,  local  measures  are  essen- 

^b^^&od  of  combating  the  lung  condition  is  the  use  of 
the  chest  compress,  which  would  be  applied  at  a  temperature  of  60 
Fa    1  repeated  every  hour  when  awake.     The  efficacy  of  the  com- 
relTL  Zuently  enhanced  by  the  application  of  a  not  fomentation 
before  every  third  or  fourth  application  of  the  compress     Where  the 
feve    is  very  high  the  compress  may  be  repeated  as  often  as  every 
twenty  mint,  es.  though,  as  before  stated,  care  must  be  taken  to  avoid 
chUling  by  evaporation.     The  action  of  the  compress  is  a  good  deal 
a   of  the  action  of  cold  in  general  in  infectious  diseases-stimulation 
aid  h,v  goration  of  the  nerve  centers  by  its  impact  upon  the  cutaneous 
"fa"  and  the  reaction  that  follows.    Reflex  influences  are  conveyed 
o  the  lungs,  and  as  a  result  congestion  is  lessened  and  expectoration 
ncreased      Upon  the  circulation  its  action  is  that  of  a  cardiac  tonic, 
Contracting  the  superficial  blood-vessels,  which  "™>£»« 
by  a  tonic  dilatation.     Reflexly,  heart  action  ,s  benefi ted      Reduction 
of    temperature  is  also  favored  by  the  application  of    the  compress 
over  to  lung,  this  being  the  seat  of  the  greatest  amount  of  h  at 
geneJuL        In  pneumonia  cold   is  more  valuable  because  of    the 
!«ae    danger  to  the  patient  of  a  persistent  high  temperature,  which 


264  PRACTICAL  HYDROTHERAPY. 

is  enfeebling  the  heart,  mechanically  overworked  already.  There  is 
no  question  but  what  the  life  cycle  of  the  germ  is  shortened  by  cold 
applications,  and  therefore  the  quantity  of  toxins  produced  lessened. 
In  the  early  stage  of  the  disease  we  do  not  expect  cardiac  collapse, 
but  should  this  be  threatened  apply  the  ice-bag  over  the  heart  for 
periods  ranging  from  ten  to  fifteen  minutes  every  hour,  repeated  as 
often  as  is  necessary. 

Dr.  T.  J.  Mays,  of  Philadelphia,  advocates  the  use  of  ice-bags  to 
the  chest  in  pneumonia.     He  says : 

"Very  often  it  is  found  that  the  application  of  ice  to  an  affected 
spot  is  immediately  followed  by  a  marked  lowering  of  the  temperature 
and  improvement  in  the  physical  signs  in  the  part.  When  we  come 
to  compare  the  results  of  the  ice-cold  treatment  of  pneumonia  with 
those  that  have  been  obtained  from  other  forms  of  treatment,  it  is 
safe  to  say  that  the  former  is  infinitely  more  satisfactory  than  the 
latter.  Cold  reduces  the  pyrexia,  strengthens  the  pulse,  tones  up  the 
heart,  diminishes  the  pain  in  the  chest,  alleviates  the  difficulty  of 
breathing  and  gives  greater  general  comfort  to  the  patient.  It  is 
capable,  however,  of  doing  a  great  deal  more.  By  virtue  of  its 
power  to  stimulate  nerve  function  and  to  contract  small  blood-vessels 
it  promotes  the  pulmonary  circulation,  relieves  stasis,  hastens  reso- 
lution and  disperses  the  products  of  exudation." 

Lees3  lays  down  the  following  rules  for  guidance  in  the  use  of 
the  ice-bag: 

"1.  Apply  the  ice-bag  over  the  dull  area,  and  especially  over  the 
advancing  edge  of  the  consolidation. 

"2.  If  the  area  is  large,  use  two  ice-bags,  or  even  three. 

"3.  Expect  to  find  a  distinct  local  effect  (less  bronchial  breathing 
and  looser  rales)  on  careful  physical  examination  after  the  ice  has 
been  applied  for  twenty-four  hours. 

"4.  If  fresh  areas  of  consolidation  develop  use  additional  ice- 
bags  ;  four  or  even  more  may  be  used  in  a  bad  case.  Correct  dosage 
is  as  important  as  with  drugs. 

"5.  Apply  hot- water  bottles  to  the  feet  and  legs.  In  children  apply 
these  before  applying  the  ice. 

"6.  Examine  the  signs  twice  daily  and  shift  the  ice-bags  accord- 
ingly. 

"7.  If  pericarditis  is  present  as  a  complication,  place  an  ice-bag 
over  the  heart. 

"8.  If  the  temperature  is  below  99°  F.,  or  if  the  hands  are  cold 
or  the  lips  blue,  remove  the  bags  for  an  hour,  then  replace  them  and 
use  them  for  two-  or  three-hour  periods,  with  one-  or  two-hour 
intervals. 

"".  In  severe  cases  with  cyanosis  and  with  a  rapid,  feeble  pulse, 
consider  whether  leeches  would  not  relieve  the  right  heart. 

"10.  Pneumonia  treated  with  ice  within  twenty-four  hours  after 
the  rigor  may  sometimes  be  aborted." 

In  this  connection  Kellogg  says  that  "several  ice-bags  may  be  used 

3   "Cohen's   System   of  Physiological  Therapeutics,"   Vol.   IX. 


NASO-PHARYNX,  LARYNX  AND  CHEST.  265 

in  place  of  the  cold  c<  mpress,  but  the  bag  should  be  removed  at  least 
every  half-hour  and  the  chest  rubbed  until  red  and  warm  to  maintain 
surface  circulation  and  skin  reflexes."  In  this  the  author  thoroughly 
agrees;  its  omission  is  a  mistake.  In  had  cases  in  children  the  full 
hot  hath,  102°  F.  or  hotter,  may  be  employed  for  two  to  five  minutes, 
followed  in  its  turn  by  the  chest  compress  at  70°  to  65°  F.  for 
twenty  to  thirty  minutes.  The  preliminary  hot  application  dilates 
the  peripheral  blood-vessels  and  relieves  the  heart. 

That  the  chest  compress  meets  every  indication  can  be  readily 
appreciated  when  we  stop  and  reflect  that  by  its  direct  action  it  lowers 
the  bacterial  life  and  activity,  thus  diminishing  the  development  of 
toxins  ;  by  tonically  dilating  the  superficial  blood-vessels  of  the  chest 
congestion  is  relieved  and  dyspnea  lessened ;  the  heart  and  vasomotors 
are  stimulated,  the  pulse  strengthened,  its  dicrotic  character  removed, 
its  rate  lowered  and  size  increased ;  the  bettered  and  less  obstructed 
circulation,  together  with  the  ingested  alkaline  beverages,  raises  blood 
pressure,  increases  the  urine  and  thus  removes  the  toxins  present; 
perspiration  is  induced,  heat  loss  favored  and  maintained  by  the 
slowly  evaporating  moisture  through  the  flannel  covering  of  the 
compress ;  the  shock  of  the  impact  of  cold  upon  the  peripheral  nerve 
terminations  rouses  and  stimulates  the  entire  central  and  vegetative 
nervous   systems,  thus    fulfilling  every  indication  and  need. 

In  many  cases  the  use  of  the  local  measures  above  indicated  will 
be  all  that  is  necessary,  although  two  or  three  times  a  day  we  may 
increase  the  vital  strength  of  the  patient  by  using  the  cold  sponge 
applied  to  the  extremities,  although  many  writers  do  not  deem  this 
an  essential  feature. 

Loomis4  says  that  in  alcoholics  he  employs  the  full  bath  at  103°  F. 
or  more  when  patients  are  delirious,  after  which  they  are  sponged 
regularly  when  the  temperature  is  102°  F.  Sweating  is  often  im- 
perative in  these  cases,  and  he  employs  the  following  method : 
Sweating  may  be  induced  by  the  hot  (110°  to  120°  F.)  foot-bath 
given  in  bed  without  any  disturbance  to  the  patient.  The  patient,  in 
a  nude  condition,  lies  between  blankets  with  his  knees  flexed,  his  feet 
in  the  tub,  which  has  been  placed  under  the  blanket,  the  long  axis 
being  in  the  line  of  the  patient's  body  and  legs ;  another  blanket  passes 
from  under  the  tub  up  over  the  end  and  over  the  knees  of  the  patient. 
From  two  to  five  blankets,  or  a  fewer  number  of  blankets  and  a 
rubber  sheet,  are  then  placed  over  the  patient,  extending  from  head 
to  foot  and  tucked  around  the  patient.  The  tub  is  at  first  filled  half- 
full  of  hot  water,  in  which  a  heaping  tablespoonful  of  mustard  has  been 
dissolved  and  hotter  water  added  as  indicated.  The  bath  is  kept  up 
for  from  thirty  to  forty-five  minutes,  according  to  the  amount  of 
sweating  produced.     During  the  application  of  the  bath  cold  cloths 

4  Loomis,    H.    P.:     "Practical    Medicine    Series   of   Year-Books,"    1906. 


266  PRACTICAL  HYDROTHERAPY. 

wrung  out  of  ice-water  or  the  ice-cap  are  kept  constantly  on  the  head 
of  the  patient. 

The  cold  full  bath  has  been  used  in  hospital  practice  by  a  number 
of  physicians,  but  the  writer  is  of  the  opinion  that  the  full  cold  bath 
is  hardly  as  satisfactory  in  this  disease  as  in  typhoid;  in  fact,  he  agrees 
with  Baruch,  that  we  will  find  in  the  compress  all  that  is  necessary 
to  overcome  the  disease,  combat  the  symptoms  and  maintain  vital 
resistance.  Brown5  states  that  he  has  found  the  full  strength  Nau- 
heim  bath  of  signal  benefit  in  these  cases,  lessening  the  respiration, 
lowering  pulse-rate,  strengthening  the  heart's  action,  preventing  en- 
feeblement  and  dilatation.  This  bath's  well-known  action  of  raising 
the  blood  pressure  not  only  takes  place  at  the  time,  but  is  sustained 
for  long  periods  afterwards. 

Certain  prominent  symptoms  may  oftentimes  be  mitigated  by  the 
use  of  hydriatic  measures.  Where  cough  is  constant  and  irritable 
the  use  of  steam  inhalations  for  ten  to  fifteen  minutes  every  hour 
should  be  employed  until  this  troublesome  symptom  is  relieved.  I 
have  seen  much  benefit  derived  from  the  taking  of  teaspoon ful  doses 
of  very  hot  water,  it  having  frequently,  in  my  experience,  stopped 
even  the  cough  of  tuberculous  patients.  In  case  of  headache,  insomnia, 
and  delirium,  the  use  of  the  cephalic  compress,  over  which  the  cephalic 
coil  cap  is  placed,  will  very  promptly  give  relief,  although  these  condi- 
tions are,  as  a  rule,  prevented  by  the  use  of  the  cold  chest  compress. 

Convalescence  is  tedious,  and  care  should  be  exercised  in  getting 
the  patient  upon  his  feet,  especial  attention  being  paid  to  the  condi- 
tion of  the  pulse  and  heart. 

Behrmann6  says  that  after  long  experience  with  hypdrotherapy  in 
pneumonia  he  has  found  it  the  best  method.  When  the  acute  stage 
terminates  and  convalescence  makes  no  progress,  as  shown  by  in- 
creased evening  temperature,  rhonchi,  dull  areas,  irritability,  increased 
thirst  and  decreased  perspiration,  vigorous  measures  are  needed. 
If  the  temperature  is  100.4°  F.  or  higher,  use  chest  pack  re-wet 
every  two,  three  or  four  hours  in  water  at  68°  to  75°  F.  (20°  to 
25°  C. )  for  one  hour,  rubbing  the  patient  dry  after  each  application. 
If  there  is  marked  differences  between  auscultation  and  percussion, 
and  the  temperature  is  normal  or  subnormal,  with  rhonchi  and  dulness, 
wet  the  pack  or  compresss  in  water  at  86°  to  91.4°  F.  (30°  to  33°  C), 
or  even  100.4°  F.  (38°  C),  using  it  the  same  length  of  time. 

Gradually  increased  diet,  which  should  be  highly  nutritious,  to- 
gether with  tonics  of  iron,  quinine,  strychnine,  hypophosphites,  etc., 
is  indicated.  When  the  patient  is  able  to  be  about  general  tonic 
measures  should  be  at  once  administered,  the  best  of  which  are  the 
incandescent  electric  light  bath,   followed  by  the  dripping  sheet,  rain 


5  Brown,    Fhilip   King:   American    Medicine,    September,    1906. 

6  Blatter  f.   klin.   Ilydrotherapie,   1904. 


NASO-PHARYNX,  LARYNX  AND  CHEST. 

bath,  jet  douches,  or  some  other  well-known  method.  Where  con- 
solidation continues  the  local  application  to  the  spot  of  the  fomenta- 
tion will  assist  materially  in  resolution.  I  have  also  found  the 
galvanic  current  of  considerable  value  in  overcoming  this  condition. 
Many  writers  recommend  blisters  and  tincture  of  iodine. 

Catarrhal  pneumonia  may  be  treated  in  the  same  general  manner 
as  lobar  pneumonia. 

Asthma;  Hay  Fever;  Hay  Asthma. 

Bronchial  asthma  is  a  paroxysmal,  spasmodic  contraction  of  the 
muscular  layer  of  the  smaller  bronchial  tubes,  characterized  by  more 
or  less  frequent  spasmodic  attacks  of  distressing  dyspnea  and  usually 
accompanied  by  chronic  bronchitis.  This  neurosis  of  the  respiratory 
apparatus  may  result  from  either  local  or  general  conditions,  espe- 
cially those  that  have  an  influence  upon  the  nervous  system.  These 
cases  are  especially  sensitive  to  atmospheric  changes,  and  easily  catch 
cold,  the  result  of  which  is  likely  to  be  an  attack  or  paroxysm  of  the 
affection.  Many  cases  have  peculiar  idiosyncrasies  that  will  cause  a 
paroxysm.  The  disease  is  essentially  a  chronic  one,  and  as  a  rule 
perfect  recovery  seldom  occurs  save  in  those  cases  that  are  due  to 
general  conditions  or  to  reflex  causes.  The  better  the  general  health, 
the  better  the  condition  of  the  nervous  system,  the  less  tendency 
there  is  to  attacks.  Drug  medication  has  proved  itself  of  compara- 
tively little  value  during  the  acute  or  chronic  stage,  and  of  the  acute 
stage  this  may  likewise  be  said  of  hydrotherapy.  Our  aim  should 
be  between  attacks  to  build  up  the  general  health,  increase  the  nerve 
tonus  and  so  harden  the  integument  as  to  reduce  the  susceptibility  of 
the  patient  to  a  minimum.  By  these  means  we  remove  the  most 
fertile  causes  of  the  attacks.  These  cases  are  very  susceptible  to  cold 
water,  and  must  be  trained  with  great  care  to  stand  its  application ; 
and  as  its  value  is  unquestioned  it  becomes  a  necessary  factor  in  the 
treatment  of  the  case. 

During  the  paroxysm  relax  the  patient  by  immersion  in  a  hot  full 
bath  (104°  F.  or  higher),  or  apply  the  fomentation  to  chest  at  140° 
to  160°  F.,  first  posteriorly  then  anteriorly,  until  relief  is  obtained. 
In  the  interparoxysmal  or  chronic  stage  apply  the  fomentation  at 
140°  F.  night  and  morning,  wearing  between  times  both  day  and 
night  a  stimulating  compress,  the  temperature  of  which  should  be  at 
the  start  85°  F. ;  gradually  reduce  the  temperature  one  degree  daily 
until  65°  F.  is  reached.  Another  excellent  method  is  to  employ  the 
full  hot  bath,  commencing  with  the  neutral  temperature  of  95°  F. 
and  increase  two  degrees  daily  to  104°  F.  or  higher  for  fifteen  to 
twenty  minutes,  followed  by  the  affusion  to  the  abdomen  of  the  water 
at  55°  F.  The  best  way  is  to  allow  the  hot  water  to  run  out  until 
there  is  only  six  inches  in  the  tub.  at  which  time  the  affusion  is  given, 


268  PRACTICAL  HYDROTHERAPY. 

while  the  patient  is  sitting  in  the  water.  It  causes  deep  inspiration 
and  expiration.  1<  rid  aids  expectoration,  relieve-   fullness  and 

stimulates  intestinal  activity.  In  institutional  cases  we  may  commence 
with  the  electric  light  bath  until  perspiration  takes  place;  remove  the 
patient  from  this  and  give  an  alcohol  rub.  He  should  now  lie  down 
and  carefully  avoid  any  chilling. 

The  writer  wishes  to  say  in  passing  that  it  is  his  opinion  that  the 
electric  light  bath  possesses  unusual  efficiency  in  the  treatment  of 
this  disease.  He  has  tried  carefully  to  analyze  in  what  manner  this 
take-  place,  and  has  been  unable  to  reach  any  exact  or  definite  con- 
clusion, but  the  clinical  fact  remains  that  it  is  the  most  satisfactory 
treatment  we  have  along  hydrotherapeutic  lines.  After  we  have 
given  two  of  these  treatments  commence  with  the  cold  sponge  at 
80c  F..  rapidly  performed,  starting  with  the  extremities  and  termi- 
nating with  the  chest.  As  soon  as  this  is  well  borne  the  water  may  be 
gradually  dropped  one  degree  a  day  until  70"  F.  is  reached.  Con- 
tinue electric  light  bath  and  substitute  for  the  cold  sponge  the  fol- 
lowing: The  dripping  sheet  at  70~"  F.  for  two  minutes  with  vigorous 
friction,  the  patient  during  its  application  standing  in  a  hot  foot-bath 
just  a-  hot  as  can  be  borne.  As  soon  as  satisfactory  reaction  is 
obtained  the  following  treatment,  which  has  given  the  author  much 
satisfaction,  may  be  instituted:  The  electric  light  bath  until  free 
perspiration  takes  place,  followed  by  the  circular  rain  bath  at  104° 
to  105°  F.  for  one  minute,  reduced  to  70:  F.  for  one-fourth  minute, 
followed  by  the  fan  douche  to  the  back  of  the  chest  at  70 =  F.  for 
one- fourth  minute.  The  pressure  should  commence  at  about  fifteen 
pounds  and  be  cautiously  and  gradually  raised  to  not  exceed  thirty 
pounds.  Foreign  writers  recommend  the  cold  chest  compress  or 
pack,  well  protected,  and  continued  for  quite  a  length  of  time. 

ciated  measures  of  considerable  value  we  may  mention 
treatment  of  any  affection  of  the  nose  or  throat  that  may  exist  Me- 
chanical vibration  systematically  applied,  as  well  as  the  static  wave 
current,  directly  to  the  chest  walls,  will  prove  additional  aids  in  treat- 
ment. I  have  seen  some  good  results  come  from  the  long-continued' 
administration  of  iodine  and  arsenic.  Digestive,  pelvic  and  rectal 
les-ions.  when  corrected,  sometimes  result  in  unexpected  benefit. 

The  treatment  above  outlined  is  also  applicable  to  ha\  fever,  hay 
asthma  and  acute  specific  catarrhal  inflammation  of  the  upper  air- 
passages  occurring  during  the  '"hay  fever  season" — that  is  to  say. 
during  the  time  of  the  presence  of  certain  pollens  in  the  air.  the  result 
of  their  action  being  to  produce  cough  and  difficult  respiration. 
Young  subjects  may  at  once  be  placed  upon  the  full  treatment  sug- 
gested. Care  should  be  taken  to  keep  the  air-passages  clean  with  alka- 
line sprays ;  limit  the  diet,  from  which  meat  has  been  wholly  removed ; 
increase   the   drinking   of   water,   correct   digestive   disturbances    and 


NASO-PHARYNX,  LARYNX  AND  CHEST.  269 

overcome  constipation.  These  cases  will  usually  be  found  to  be  neu- 
rotics who  lead  a  sedentary  life  and  who  are  the  subjects  of  lithemia 
and  auto-intoxication.  The  ophthalmic  surgeon  should  be  called  in 
to  remove  any  irregularities  of  the  respiratory  passages.  Where 
chronic  bronchitis  exists  between  "seasons,"  this  condition  should  be 
carefully  overcome.  The  most  satisfactory  results,  however,  are  ob- 
tained by  the  removal  of  the  patient  from  the  presence  of  the  irri- 
tating causes  of  the  trouble. 

Emphysema. 

Vesicular  emphysema  is  a  dilatation  of  or  increase  in  the  size 
of  the  lung  vesicles,  characterized  by  an  enlargement  or  distension 
of  the  lung,  difficulty  of  breathing,  enlargement  of  the  thorax,  and 
oftentimes  dilatation  of  the  heart.  It  is  a  chronic  disease  that  rarely 
proves  fatal,  but  which  gives  the  sufferer  considerable  discomfort, 
largely  due  to  the  associated  asthmatic  attacks  and  continued  difficulty 
of  breathing.  Its  principle  danger  is  the  cardiac  changes  that  take 
place,  and  in  the  treatment  of  emphysema  we  should  take  these  into 
consideration.  Intercurrent  attacks  of  pneumonia  demand  treatment 
and  careful  attention  along  the  lines  laid  down  for  that  disease.  Our 
aim  should  be  the  reconstruction  of  the  general  health  as  a  necessary 
basis  and  the  treatment  of  the  emphysematous  condition.  These 
cases  should  be  gradually  trained  to  stand  tonic  hydrotherapeutic 
procedures.  Commence  the  treatment  with  the  electric  light  bath  or 
hot  blanket  pack  until  perspiration  commences,  following  this  with 
the  cold  sponge  at  70°  F.,  rapidly  performed.  After  two  or  three 
davs  of  this  treatment  we  may  substitute  the  dripping  sheet  at  70° 
for  three  minutes,  with  vigorous  friction,  taking  care  to  have  the  pa- 
tient stand  in  a  hot  foot-bath  at  110°  to  115°  F.  during  its  applica- 
tion. As  soon  as  satisfactory  reaction  has  been  secured  we  may  adopt 
these  measures :  The  daily  use  of  the  electric  light  or  hot-air  bath  to 
perspiration ;  follow  this  by  the  horizontal  or  circular  rain  bath  at 
100°  to  104°  F.  for  one  and  one-half  minutes  ;  reduce  the  temperature 
to  70°  F.  for  one-fourth  minute,  twenty  pounds  pressure ;  reduce  tem- 
perature one  degree  daily  to  60°  F.  and  increase  pressure  one  pound 
daily  until  thirty  is  registered.  When  these  temperatures  are  reached 
add  to  the  treatment  the  alternate  or  Scottish  douche  to  the  spine. 
The  hot  water  in  this  treatment  should  range  from  105°  to  110°,  the 
cold  water  60°  F.  Give  the  hot  water  for  ten  to  fifteen  seconds,  the 
cold  five  to  ten ;  three  alternations  are  sufficient.  The  alternate  or 
Scottish  douche  has  a  direct  influence  upon  the  emphysematous  con- 
dition in  the  lung,  and  is  a  very  valuable  method  of  reaching  this 
disease.  Where  there  is  weakness  or  irregularity  in  heart  action  we 
may  apply  twice  daily  the  precordial  compress,  over  which  the  ice- 


270  PRACTICAL  HYDROTHERAPY. 

bag  is  placed.     Apply  these  latter  measures  morning  and  night  and 
the  hydriatic  measures  in  the  middle  of  the  day. 

Strasser  suggests  the  use  of  the  trunk  compress,  half  pack  at  60°  F. 
for  thirty  to  sixty  minutes,  followed  by  the  half  bath  at  50°  to  60°  F. 
Where  dilatation  of  the  heart  exists  the  carbon  dioxide  bath  and 
method  of  resistive  exercise,  as  carried  out  under  the  Schott  system 
of  treatment,  will  prove  a  valuable  addition  in  the  treatment  of  this 
complication. 

Tuberculosis. 

Under  this  heading  all  forms  of  tuberculosis  are  considered,  it 
being  left  to  the  practitioner  to  individualize  a  trifle  in  the  treatment 
of  certain  conditions  peculiar  to  the  different  tuberculous  processes. 
Tuberculosis  is  an  infectious  disease,  affecting  man  and  animal.  It 
is  incited  by  the  bacillus  tuberculosis  in  such  cases  where,  by  heredity, 
environment  or  other  means,  the  tissues  are  devitalized.  It  is  charac- 
terized by  an  exudative  and  productive  inflammation,  in  which  ne- 
crosis of  the  affected  tissues  is  observed.  Morphologically,  the  tissue 
reaction   consists   of   small   nodular   bodies — tubercles. 

Prophylaxis. — For  the  tuberculous  disease  to  manifest  itself  in  a 
living  organism  two  things  are  necessary — presence  of  the  bacillus  and 
a  condition  suitable  to  its  development.   The  first  aim,  therefore,  should 
be  the  destruction  of  the  germ  and  the  prevention  of  an   infection. 
As  long  as  the  sputum  remains  in  the  liquid  state  there  is  less  danger 
from  it,  but  matter  expectorated  on  the  floor,  in  the  street  or  in  a 
handkerchief   usually    dries   very   rapidly,   and,    becoming   pulverized, 
finds  its  way,  by  inhalation,  into  the  respiratory  tract.     To  this  end 
the  pocket-flask,  when  properly  and   faithfully  used  by  the  tubercu- 
lous, proves  an   immediate   factor  in  the  prevention  of  this  disease. 
They  should  be  most  thoroughly  cleansed  by  placing  the  flask,  con- 
tents and  all,  in  boiling  water  to  which  some  bicarbonate  of  soda  has 
been  added,  where  they  are  left   for  five  or  ten  minutes.     This  will 
destroy  tubercle  bacilli  most  certainly.     The  pleasant  but  unsanitary 
habit  of  kissing  sick  people  has  often  led  to  the  transmission  of  the 
disease  from  one  member  of  the  family  to  another ;  the  habit  of  kissing 
domestic  pet  animals  is  equally  dangerous.     Pathologists  handling  fresh 
tuberculous  specimens,  physicians  performing  autopsies  and  students 
dissecting,  are  exposed  to  the  danger  of  tuberculosis.     To  walk  and 
breathe    the   atmosphere   behind    a    woman    dragging   her   dress    over 
dusty,  dirty  sidewalks,  often  dotted  with  deposits  of  buccal,  bronchial 
and  pulmonary  secretions  containing  various  pathogenic  microbes,  at 
other  times  mixed  with  tobacco  juice,  must  be  dangerous  to  the  health 
of  every  one.     Tuberculously  predisposed   individuals   should   be   in- 
structed that  they  may  become  strong  and  healthy,  and  that  the  acci- 
dental  inhalation  of  tubercle  bacilli  will  not  be  sufficient  to  produce 


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NASO-PHARYNX,  LARYNX  AND  CHEST.  271 

consumption.  Those  in  fair  health,  living  a  regular  and  hygienic  life, 
have  little  to  fear.  It  is  the  anemic,  dyspeptic,  toxemic  individual, 
of  low  vitality  that  makes  a  candidate  for  tubercular  disease.  Every  ef- 
fort should  be  made  to  secure  good  appetite  and  the  digestion  of  plenty 
of  simple  and  wholesome  food.  Fresh  air,  sunlight  and  out-of-door  ex- 
ercise are  valuable.  Alcohol  in  any  of  its  forms  should  never  he 
used.  Resort  to  the  use  of  cold  water,  with  its  stimulating,  invigor- 
ating and  tonic  properties,  is  one  of  the  best  known  prophylactic 
measures  in  existence.  It  certainly  develops  vigorous  action  of  the 
vasomotor  system,  prevents  congestion  and  catarrh,  and  gives  a  ro- 
bustness not  alone  against  the  tubercular,  but  any  infection.  It  can  be 
instituted  at  an  early  age.  A  child  a  few  months  old  can  support 
with  impunity,  after  the  use  of  its  warm  cleansing  bath,  a  rapid 
sponging  off  with  cold  water,  followed  by  a  relatively  vigorous  fric- 
tion with  a  soft  towel.  As  growth  takes  place  he  should  not  only  he 
taught  the  use  of  the  cold  water  after  his  semi-weekly  bath,  but  each 
morning  should  bathe  the  face,  neck  and  chest,  "down  to  the  waist," 
with  cold  water.  If  access  can  be  had  to  swimming  baths,  showers 
or  sprays,  they  should  be  utilized,  winter  and  summer  alike.  It 
is  my  candid  opinion  that  anemic,  dyspeptic  and  toxemic  individuals 
who  are  candidates  for  consumption  can,  through  a  graduated  course 
of  tonic  hydrotherapy,  prevent  its  inception ;  in  fact,  it  is  with  them 
almost  a  specific.  /  have  yet  to  see  the  individual  whd  could  not,  bv 
a  judicious  training,  be  brought  to  bear  vigorous  methods;  all  that 
is  necessary  is  to  secure  reaction  and  a  gradual  education  of  the  skin 
and  nervous  system.  If  necessary,  start  with  the  cold  sponge  rapidly 
performed,  best  by  the  patients  themselves,  then  the  affusion,  and  last 
the  douche.  Always  follow  these  methods  with  friction  by  the  hand 
and  afterward  with  a  coarse  towel,  and  what  will  be  said  with  ref- 
erence to  air  and  sunlight  in  the  treatment  of  developed  tuberculous 
applies  to  these  individuals.  We  should  always  bear  in  mind  what 
Loomis  has  said  upon  the  question  of  inheritance:  "My  experience 
has  led  me  to  believe  that  tuberculous  heredity  has  very  little  to  do 
with  the  question  of  a  person's  recovery,  all  other  things  being  equal. 
Of  twenty  persons  known  to  me  who  have  recovered  from  phthisis 
during  the  past  year  alone,  nine  have  pronounced  tuberculous  his- 
tories.    One  had  two  brothers  and  one  sister  to  die  of  phthisis." 

The  successful  treatment  of  tuberculosis  may  be  conducted  in  all 
climates.  Care  must  be  taken  to  prevent  self-infection  by  swallowing 
the  sputum,  and  to  prevent  infecting  others  by  expectorating  only  in 
pocket-flasks,  never  indiscriminately.  The  bed-clothing,  knives,  forks, 
dishes,  and  other  tableware  used  by  consumptives,  must  be  carefully 
sterilized.  The  sleeping  apartment  should  be  ample  and  the  patient 
must  always  sleep  alone.  The  bed  should  be  set  with  the  head  against 
an  inside  wall ;  the  mattress  must  be  hard,  and  never  feathered ;  the 


272.  PRACTICAL  HYDROTHERAPY. 

room  well  ventilated  and  kept  open  most  of  the  time.  At  night  the 
patient  should  sleep  with  the  window  open,  rain  or  shine,  cold  or 
warm,  foggy  or  clear,  wide  open  in  summer,  half-open  in  winter. 

There  should  never  be  any  fear  of  night  air,  for  in  cities  it  is 
really  purer  than  in  the  day  time.  The  room  should  contain  no  car- 
pets or  hangings. 

As  much  time  as  possible  should  be  spent  in  the  open  air,  as  far 
as  possible  at  rest,  protected  from  the  wind,  keeping  the  body  con- 
stantly in  the  sunshine.  At  Falkenstein  patients  stay  out  seven  to  ten 
hours  daily  in  chairs,  despite  rain,  fog,  wind,  snow,  and  the  thermom- 
eter below  zero.  While  resting  in  the  chair  patients  may  read  or  write, 
but  should  endeavor  to  secure  perfect  muscular  relaxation,  for  by 
so  doing  they  favor  strength  and  reduce  fever.  Their  lower  limbs 
should  be  covered  with  lap  robes  or  blankets.  As  they  gain  strength 
short  walks  may  be  taken,  or  the  patient  rise  every  hour  for  a  short 
breathing  exercise.  The  dress  is  negligee  and  comfortable ;  the  under- 
wear light,  woolen  union  suit ;  the  shirt  negligee,  the  cap  ventilated, 
shoes  thick-soled  and  rubber  heeled.  Women  must  wear  short  skirts 
that  do  not  touch  the  ground,  should  follow  the  Lady  Huberton,  Miller 
style.  The  divided  skirt  as  an  outer  dress  is  often  advisable.  All 
clothes  should  be  hung  from  the  shoulder ;  never  constrict  the  waist 
nor  interfere  with  abdominal  breathing;  corsets  are  to  be  avoided, 
but  if  used  must  be  light,  or,  what  is  preferable,  a  waist.  Never  con- 
strict, the  neck  or  wear  tight  shoes;  heavy  soles,  rubber  heels  for  or- 
dinary wear,  with  gum  shoes  in  cold  weather.  Men  should  not  be 
permitted  to  smoke  or  chew  tobacco. 

The  diet  should  be  a  nourishing  one,  and  the  patient  really  overfed. 
All  the  food  that  can  be  assimilated — that  is  to  say,  a  mixed  diet  of 
proteids,  carbohydrates  and  fats — for  the  digestive  power  often  far 
exceeds  the  appetite  and  eating  capacity  of  the  patient.  Frequent 
feeding  has  been  suggested :  Breakfast  7  to  7  :30,  to  consist  of  bread, 
butter,  honey,  cocoa  or  chocolate,  and  two  or  three  glasses  of  milk ; 
10  a.m.,  bread,  butter,  cold  meats,  fruits,  etc. ;  1  p.m.,  soups,  fish,  meat, 
vegetables,  salads,  preserves,  dessert,  fresh  fruit,  and,  if  necessary, 
a  glass  of  wine;  4  p.m.,  milk,  bread,  butter;  7  to  7:30  p.m.,  soup,  pota- 
toes, rice,  cold  meat,  bread,  butter,  salad,  cooked  fruit,  two  glasses  of 
milk;  9  p.m.,  two  glasses  of  milk,  and,  if  necessary,  a  "pony"  of 
cognac.  The  large  use  of  milk  may  be  made  digestible  by  the  use 
of  five  grains  of  bicarbonate  of  soda  and  five  grains  salt.  Certain 
prepared  foods  may  be  added  to  the  above  dietary,  viz.,  koumyss, 
plasmon,  tropon,  etc. 

Hydrotherapy  in  its  action  is  essentially  tonic,  and  this  is  what 
the  tuberculous  person  needs.  Its  aim  should  be  the  training  of  the 
cutaneous  and  nervous  systems  to  stand  low  temperatures,  followed 
by  vigorous  and  prompt  reaction.     To  accomplish  this  the  treatment 


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NASO-PHARYNX,  LARYNX  AND  CHEST.  273 

must  be  adapted  to  the  individual,  and  his  system  gradually  educated 
to  stand  the  treatment.  It  has  been  the  observation  of  Dettweiler, 
Knopf  and  other  noted  therapeutists  in  this  ljne,  that  this  agent  pos- 
sesses a  power  for  good  that  is  almost  incalculable.  Its  action  is  to 
produce  a  stimulation  of  the  sensory  nerves  in  the  skin,  which  is 
transmitted  to  the  sensory  nervous  system,  invigorating  it  and  every 
function  dependent  upon  it.  The  respiration  is  deepened,  nutritive 
processes  increased,  circulation  made  more  active,  appetite  and  di- 
gestion bettered,  and  nerve  tone  strengthened.  Another  important 
consideration  is  the  "toughening"  the  skin  receives  from  the  appli- 
cation of  cold  water,  as  a  result  of  which  the  neuro-vascular  struc- 
tures are  stimulated  and  are  enabled  to  adapt  themselves  to  varying 
conditions  of  temperature,  with  the  result  that  the  patient  does  not 
"take  cold." 

It  has  been  the  writer's  plan  to  commence  the  treatment  with  the 
use  of  dry  friction  with  a  coarse  towel,  once  or  twice  a  day — that 
is  to  say,  on  arising  and  retiring.  This  is  followed  by  the  use  of  mas- 
sage and  mechanical  vibration.  By  these  preliminary  measures  we  have 
enhanced  the  reactive  capacity  of  the  patient.  All  hydriatic  treatment 
must  be  given  in  a  warm  room.  These  cases  will  do  better  where  the 
treatment  is  preceded  by  some  heating  method.  In  the  home  we 
may  employ  the  dry  full  pack,  full  hot  bath  at  102°  F.,  or  the  "home" 
hot-air  cabinet  until  perspiration  becomes  barely  perceptible,  fol- 
lowed by  a  rapid  general  sponge,  commencing  at  90°  F.,  reducing 
two  degrees  daily  to  70°  F.  and  one  degree  daily  to  60°  F.  This  is 
best  performed  in  a  warm  bath-room  by  the  patient  himself.  Care 
must  be  taken  to  prepare  the  cold  water  in  a  bucket  beside  the  tub 
before  the  bath  is  entered.  "Rub  down"  with  a  crash  towel  till  all 
aglow — that  is,  securing  good  reaction.  This  may  be  used  on  arising 
or  in  the  forenoon,  and  at  night  a  stimulating  chest  compress  applied, 
commencing  at  80°  F.  and  reducing  two  degrees  daily  to  60°  F. 
This  is  to  be  worn  all  night.  Where  a  "shower"  can  be  attached  to 
the  bath-tub  it  will  be  found  of  signal  benefit,  and  should  be  substi- 
tuted for  the  sponge  as  soon  as  a  temperature  of  70°  F.  is  reached. 
If  the  chest  compress  is  not  worn  it  is  an  excellent  plan  to  rapidly 
sponge  the  chest  and  upper  trunk  with  water  at  60°  just  before  retiring. 
To  increase  appetite  apply  the  ice-bag  to  the  epigastric  region  for 
half  an  hour  prior  to  the  three  principal  meals.  Where  much  dis- 
turbed by  cough  the  sipping  of  hot  water  relieves.  In  the  institutional 
management  of  these  cases  we  may  select  the  hot  air,  vapor,  or  in- 
candescent electric  light  bath,  which  latter  I  much  prefer.  It  should 
be  administerd  for  a  short  period  and  stopped  at  the  commencement 
of  perspiration ;  under  no  circumstances  should  profuse  perspiration 
be  induced.  As  soon  as  the  patient  is  sufficiently  warmed  he  is  re- 
moved from  the  electric  light  bath  and  given  a  preliminary  treatment 


274  PRACTICAL  HYDROTHERAPY. 

(rain  bath  or  douche)  of  warm  water,  followed  by  the  cold  treat- 
ment. Commence  with  the  sponge  at  80°  F.,  rapidly  reducing  two  to 
three  degrees  F.  daily  to  65°  F.,  paying  especial  attention  to  the  apices 
and  spine,  followed  by  vigorous  friction  and  good  reaction.  Next 
move  to  the  circular  needle  rain  bath  at  100°  F.  for  one  minute,  re- 
duced to  65°  F.  for  ten  to  fifteen  seconds.  Now  institute  the  full 
daily  treatment  as  follows :  Electric  light  bath  till  perspiration  com- 
mences ;  circular  needle  rain  bath  at  100°  F.  for  one  minute ;  fan  douche, 
65°  F.,  to  entire  body  ten  seconds ;  jet  douche  to  legs,  spine  and  apices, 
front  and  rear,  ten  seconds.  During  the  application  of  the  cold 
water  it  is  a  good  plan  to  have  the  mouth  open  wide  in  order  that 
deep  respirations  may  be  taken,  and  to  move  the  arms,  legs  and  chest, 
as  this  will  reduce  the  shock  of  the  impact  of  cold  water  and  favor 
reaction.  The  treatment  should  be  finished  with  good  friction  in  a 
warm  room,  first  with  the  hand  and  afterward  with  a  Turkish  towel. 
Knopf  suggests  using  the  douche  first  on  the  feet,  rapidly  passing 
up  to  the  hips,  and  spray  over  the  body.  I  have  found  this  an  excel- 
lent plan,  and  usually  finish  the  treatment,  where  the  patients  are 
able  to  stand  it,  with  the  jet  to  the  apices  and  up  and  down  the  spine. 
The  patients  should  be  frequently  weighed,  a  gain  in  weight  indi- 
cating success  and  loss  a  failure  to  adapt  hydriatic  methods  to  the 
case.  The  best  time  for  the  bath  is  the  morning  hours,  and  each  treat- 
ment should  be  followed  by  a  lunch.  In  some  cases  I  have  found  it 
advisable,  when  their  reaction  is  well  developed,  to  follow  the  elec- 
tric light  bath  directly  by  the  cold  water  treatment,  better  response 
being  thus  obtained.  A  chilly  sensation  after  the  bath  should  indi- 
cate a  change  in  temperature  and  duration. 

Baruch,7  in  speaking  of  the  forlorn  cases  that  come  to  the  Monte- 
fiore  Home  for  chronic  invalids,  says  that  he  has  been  led  to  adopt 
the  following  course,  because  the  skins  of  many  of  these  poor  people 
have  long  been  strangers  to  cold  water,  or,  indeed,  water  of  any  kind : 

"After  the  thorough  cleansing  with  a  warm  bath  or  soap  ablution, 
a  day  is  allowed  to  elapse.  The  patient  is  now  wrapped  snugly,  quite 
naked,  in  a  woolen  blanket,  so  that  his  body  is  excluded  from  the  air; 
other  blankets  are  piled  over  him,  the  windows  are  opened  and  he  is 
given  a  small  glass  of  iced  water  every  ten  minutes.  Having  lain  in 
this  position  an  hour,  a  part  of  the  body  is  exposed  and  bathed,  as 
follows :  With  a  towel  the  face  is  bathed  in  water  at  50°  F. ;  a  basin 
of  water  at  75°  F.  is  made  ready,  into  which  the  attendant  dips  his 
right  hand,  covered  by  a  mitten  or  glove  of  Turkish  toweling.  One 
arm  having  been  exposed,  it  is  rapidly  washed  and  rubbed  with  the 
wet  glove  dipped  in  water  at  75°  F.,  then  dried  and  replaced  under 
the  blanket.  Other  parts  are  successively  treated.  At  the  termination 
of  this  ablution  the  patient  is  rapidly  rubbed  with  a  coarse  towel. 
This  treatment  is  repeated  daily,  the  temperature  of  the  water  being 
reduced   two   degrees   on   each   occasion   until   60°    is   reached.      The 

7   Baruch,    Simon:    "Hydrotherapy,"    1906,   p.    351. 


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NASO-PHARYNX,  LARYNX  AND  CHEST.  275 

dripping  sheet  is  now  indicated.  The  result  is  usually  an  improved 
appetite,  better  digestion  and  assimilation,  improved  hematosis, 
deepened  respiration,  vigorous  circulation — in  brief,  an  enhancement 
of  all  those  functions  which  contribute  to  the  maintenance  of  health 
and  on  whose  integrity  depends  the  prolongation  of  life." 

Morris8  says  that  a  certain  number  of  cases  fail  to  respond  to 
treatment  because  of  the  heart  weakness  present.  Upon  examination 
they  will  be  found  to  have  a  dilated  heart,  high  pulse-rate  and  tem- 
perature. In  these  cases  a  valuable  adjunct  to  the  general  manage- 
ment of  cases  is  the  Nauheim  bath,  applied  as  though  we  were  treat- 
ing the  cardiac  condition  alone.  His  results  were  excellent.  The 
dilatation  lessened,  pulse-rate  and  temperature  declined  and  arterial 
tension  rose.  In  two  cases,  in  the  incipient  stage,  the  author  has 
himself  seen  the  cardiac  condition  clear  up  and  the  pulmonary  lesion 
improve.     Subsequent  treatment  "cured"  the  cases. 

Certain  symptoms  prominent  in  the  disease  can  be  treated  satis- 
factorily by  hydriatic  methods.  Tuberculous  pyrexia  demands  spe- 
cial management — absolute  rest  in  bed,  in  a  well-ventilated  room, 
with  as  much  fresh  air  as  possible ;  internal  administration  of  cold 
water,  lemonade  or  orangeade.  The  rule  should  be  that  the  higher  the 
temperature  the  more  tepid  the  water.  We  should  start  with  a  par- 
tial and  then  an  entire  cold  sponge.  Winternitz9  suggests  water  at 
65°  to  55°  F.,  sponging  the  parts  in  the  order  named:  Hands,  fore- 
arms, face,  throat,  neck,  arm-pits,  back,  stomach  and  lower  extremi- 
ties. The  parts  should  be  exposed  as  little  to  the  air  as  possible, 
should  be  sponged  and  dried  rapidly  ;  repeat  three  to  four  times  daily. 
We  may  next  proceed  to  the  use  of  the  cold  compress  or  a  partial 
pack,  applying  first  to  the  legs  and  then  to  the  arms,  or  alternating 
every  hour.  Where  there  is  the  slightest  tendency  to  cardiac  col- 
lapse the  ice-bag  should  be  applied  to  the  precordia.  The  cold  enema 
oftentimes  reduces  temperature  nicely. 

Cough  and  night-sweats  are  best  prevented  by  rest,  sleeping  in  a 
cool  room,  with  plenty  of  fresh  air,  light  bed-clothes  and  the  wearing 
of  no  underwear  in  bed.  The  chest  compress  is  the  best  method, 
being  careful  to  cover  the  apices  thoroughly,  using  water  at  a  tem- 
perature of  55°  F.,  the  compress  being  covered  by  a  flannel  compress 
and  remaining  on  all  night.  In  the  morning  remove  the  compress 
and  quickly  sponge  the  chest  with  water  at  60°  F.,  followed  by  fric- 
tion. This  same  treatment  will  help  to  overcome  the  insomnia  and 
restlessness  often  found  in  these  cases. 

Climate  alone  will  never  cure  phthisis,  and  as  the  vast  majority 
are  among  those  who  cannot  afford  trips  and  long  sojourns,  it  stands 


8  Morris,   Geo.    W. :   American    Medicine,    February,    1907. 

9  Winternitz,    Wm. :    "Hydrotherapy,"   Cohen's   system    of   Physiological   Therapeutics,    Vol. 
IX,    1902. 


276  PRACTICAL  HYDROTHERAPY. 

to  reason  they  must  follow  out  a  strict  and  rigid  treatment  and  disci- 
pline, no  matter  where  they  may  be.  1  have  seen  "lungers"  on  the 
Riviere,  at  Monte  Carlo,  Nice,  and  other  Mediterranean  resorts, 
smoking,  gambling  and  living  unhygienically  under  the  fatuous  be- 
lief that  climate  would  effect  a  cure.  It  is  certainly  a  comforting  doc- 
trine and  reassuring  to  those  who  cannot  get  away,  that  the  tubercu- 
lous patient,  of  whatever  country  or  race,  can  be  suitably  treated  not 
far  from  his  own  home. 

Education  and  discipline  are  paramount  factors  in  the  treatment. 
The  tuberculous  may  aid  in  their  recovery  by  practicing  breathing 
exercises,  and  by  changing  their  underwear  if  they  perspire  much.  He 
should  never  leave  the  house  before  sunrise  and  remain  in-doors 
during  sunset ;  retire  very  early,  never  read  in  bed,  and  secure  nine 
hours'  sleep  if  possible.  Cheerfulness  and  happiness,  with  a  willing- 
ness to  follow  out  all  that  science  has  learned  with  regard  to  what 
is  good  for  his  disease,  will  enable  him  to  make  a  recovery  which 
otherwise  would  be  impossible. 

Summed  up  in  a  nutshell,  the  ideal  treatment  of  the  tuberculous 
patient  consists  in  having  him  live  in  a  high,  elevated  and  dry  climate, 
residing  in  a  tent  or  tent-house,  within  easy  access  of  a  central  insti- 
tution, where  he  may  obtain  proper  and  nutritious  diet  and  hydro- 
therapeutic  treatment,  with  facilities  for  pleasant  rides  and  drives, 
unexciting  games  and  such  companionship  with  books  and  friends 
as  will  prevent  too  great  intrusion  of  ennui  and  self. 

The  influence  of  hydrotherapy  is  to  stimulate,  in  an  unparalleled 
manner,  nervous  function,  to  relieve  congestion  and  develop  a  neuro- 
vascular power  equalled  only  by  active  muscular  exercise.  It  deep- 
ens respiration,  increases  the  oxygenating  power  of  the  blood,  favors 
the  elimination  of  carbon  dioxide  and  other  waste  materials.  It  in- 
creases appetite  and  digestion,  and  as  a  result  more  food  is  taken  and 
assimilated,  and  thus  a  gain  in  flesh  is  possible,  while  at  the  same  time 
reparative  factors  are  removing  the  diseased  process  and  making 
good  the  damage  already  done,  for  by  means  of  increased  circulation, 
by  nerve  action  and  increased  oxygenation,  waste  products  are  de- 
stroyed and  more  rapidly  removed  from  the  system.  Every  gland 
in  the  body  is  stimulated,  and  by  this  means  better  and  more  active 
glandular  products  produced.  Its  energizing  influence  upon  the  heart 
and  blood-vessels  causes  an  increase  of  blood  circulation,  the  removal 
of  stasis,  congestion  and  inflammation,  wherever  they  may  be ;  this  I 
have  seen  time  and  again  in  all  classes  of  patients.  It  checks  night- 
sweats,  reduces  cough,  favors  expectoration  and  relieves  temperature. 
It  will  thus  be  readily  seen  that  it  sets  in  action  the  entire  tissues  and 
structures  of  the  patient  that  are  essential  to  the  maintenance  of 
health  and  physical  integrity. 


NASO-PHARYNX,  LARYNX  AND  CHEST.  277 

Prevention   of  Acute   and   Chronic   Respiratory   Inflammations. 

The  basic  treatment  in  the  prevention  of  these  inflammations,  or,  in 
fact,  any  other  form  of  inflammatory  disturbances  of  the  human  sys- 
tem, is  to  gradually  train  the  cutaneous  blood-vessels  to  stand  varying 
changes  in  temperature  and  moisture,  and  this  is  largely  a  matter  of 
training  the  cutaneous  nervous  system  to  withstand  impressions  that 
would  otherwise  markedly  influence  the  vasomotor  centers.  Nearly 
all  those  who  are  unusually  susceptible  to  those  influences  that  pro- 
duce inflammation  are  the  subjects  of  lowered  vital  resistance  and 
live  under  vitiating  influences.  For  this  reason  we  should  use 
every  means  that  will  improve  the  general  nutrition,  especially  keep- 
ing in  mind  that  the  digestion  and  elimination  are  two  factors  never 
to  be  lost  sight  of.  Moderate  eating,  the  free  use  of  fruits,  the  drink- 
ing largely  of  plain  or  carbonated  water,  the  regulation  of  constipa- 
tion and  the  insistence  upon  normal  nose-breathing  are  essentials. 
Nothing  in  the  range  of  medicine  equals  cold  water  as  a  preventive 
measure.  Where  individuals  have  no  access  to  institutional  treat- 
ment we  may  insist  upon  their  using  cold  water  twice  daily.  In  the 
morning  the  rapid  cold  sponge  at  60°  F.  over  the  entire  body,  or  the 
cold  shower  at  60°  F.  for  ten  to  fifteen  seconds,  followed  by  a  brisk- 
rub  down  with  a  rough  Turkish  towel,  together  with  the  use  of  a  few 
free  hand  exercises,  will  be  found  a  most  satisfactory  measure.  In 
the  afternoon  or  evening,  if  he  can  secure  a  swimming  bath,  it  will 
be  found  most  advantageous,  but  where  this  is  not  possible  the  same 
treatment  may  be  again  repeated  in  the  evening.  In  large  cities  the 
Turkish  bath  may  be  used  in  conjunction  with  the  bath  treatment 
once  weekly. 

Institutions  and  sanatoria  find  the  electric  light  bath  to  the  point 
of  perspiration,  followed  by  certain  tonic  hydriatic  measures,  the  most 
satisfactory.  Commence  with  the  electric  light  bath  until  free  perspi- 
ration takes  place,  followed  by  the  horizontal  rain  bath  at  102°  F. 
for  one  and  one-half  minutes,  reduced  to  70°  F.  for  one-fourth  to  one- 
half  minute,  twenty  pounds  pressure.  Reduce  temperature  one  to  two 
degrees  daily  until  60°  F.  is  reached  and  increase  pressure  two  pounds 
until  thirty  is  registered;  follow  by  the  cold  foot-bath,  60°  to  50°  F., 
for  one-fourth  to  one-half  minute.  As  soon  as  the  patient  is  able 
the  following  roborant  measures  will  be  found  most  satisfactory:  Elec- 
tric light  bath  to  free  perspiration ;  horizontal  rain  bath  at  104°  F.  for 
one  and  one-half  minutes,  followed  by  the  fan  douche  to  the  entire 
body  and  jet  douche  to  the  spine,  each  one-fourth  minute  at  60°  F., 
thirty  pounds  pressure;  cold  foot-bath  at  50°  F.  one- fourth  minute. 

Pleuritis. 
Pleurisy,  or  "stitch  in  the  side,"  is  an  inflammation  of  the  pleura 
characterized  by  a  sharp  pain  in  the  side,  dry  cough,  dyspnea  and 


278  PRACTICAL  HYDROTHERAPY. 

fever.  It  may  be  acute  or  chronic,  local  or  general,  and  involve  one 
or  both  sides.  It  most  frequently  occurs  secondarily  to  other  dis- 
eases. Local  conditions  occur  from  localized  influences  such  as 
trauma  or  local  diseases.  The  disease  usually  terminates  in  recovery, 
though  this,  of  course,  depends  upon  the  causal  influences  that  exist. 
Hydrotherapy  is  one  of  the  most  valuable  treatments  that  can  be 
used  in  connection  with  this  affection,  and  the  success  that  it  has 
attained  in  the  hands  of  experts  can  be  duplicated  by  the  general 
practitioner  if  he  exercise  a  little  patience  and  ingenuity.  In  the 
treatment  of  this  affection  the  patient,  of  course,  should  be  put  to 
bed  and  kept  there.  The  diet  should  be  restricted  to  liquids  and 
water  drunk  freely.  It  is  an  excellent  plan  to  commence  the  treat- 
ment with  a  good-sized  dose  of  calomel,  followed  by  a  -aline,  though 
this  should  not  delay  the  immediate  application  of  hydrotherapeutic 
measure-,  firoad  strips  of  adhesive  plaster  are  applied  to  the  affected 
side  to  secure,  as  far  as  possible,  physiological  rest,  and  where  this 
is  necessary  it  may  be  applied  and  hydrotherapeutic  measures  used 
over  the  strips.  During  the  earlier  stages  of  the  disease  begin  the 
treatment  with  the  application  of  a  fomentation  at  120°  to  150°  F. 
for  ten  minutes  to  the  affected  side  or  spot  beneath  which  the  friction 
murmur  is  heard.  As  soon  as  this  is  removed  apply  the  stimulating 
chest  compress  at  65 '"  to  60°  F.,  seeing  that  the  bandage  over  the 
compress  is  drawn  very  tight.  This  should  remain  in  position  for 
one  or  two  hours,  depending  upon  the  case,  when  it  can  be  removed 
and  the  entire  step  of  fomentation  and  compress  repeated.  It  is 
often  an  excellent  plan  to  place  over  the  compress  a  broad  flat  ice-bag 
or  Leiter  coil  through  which  is  passed  water  at  a  temperature  of  from 
60°  to  50°  F.  The  chest  compress  and  ice-bag  exert  an  antiphlo- 
gistic effect,  relieve  pain  and  prevent  exudation.  Oftentimes  good 
can  be  accomplished  by  the  application  of  the  full  wet  pack  at  70°  F. 
for  one  to  two  hours,  followed  by  the  half  bath  at  65°  F..  accom- 
panied by  friction.  When  exudation  take>  place  we  may  continue 
the  same  treatment  as  recommended  during  the  dry  stage,  although 
it  will  be  found  especially  valuable  at  this  time  to  use  the  full  wet 
pack  of  one  or  two  hours'  duration.  During  the  stage  of  absorption 
it  becomes  necessary  to  remove  the  serous  exudate  and  build  up  the 
general  health.  Where  this  exudate  is  large  it  i>  probably  best  to 
aspirate  same  and  follow  with  the  treatment  hereinafter  suggested. 

We  may  commence  with  the  daily  use  of  the  electric  light  bath 
or  hot-air  bath  to  the  point  of  perspiration,  followed  by  the  dripping 
sheet  at  70°  F.  for  three  minutes,  with  vigorous  friction,  reducing 
water  two  degrees  daily  until  60°  F.  is  reached.  This  treatment  may 
be  supplemented  by  the  use  of  the  stimulating  chest  pack  at  65°  F., 
tightly  applied  and  repeated  every  three  hours.  As  soon  as  reactive 
and    other    capacities    of    the    patient    justify    we    may    institute    the 


NASO-PHARYNX,  LARYNX  AND  CHEST.  279 

following:  Electric  light  bath  or  hot-air  bath  to  the  point  of  mod- 
erate perspiration ;  follow  this  with  the  horizontal  or  circular  rain 
bath  at  100°  to  105°  F.  for  two  minutes,  reduced  to  70°  F.  for  one- 
half  minute,  pressure  twenty  pounds.  Decrease  temperature  two 
degrees  daily  until  60°  F.  is  reached  and  increase  pressure  two  pounds 
daily  until  thirty  is  registered. 

In  chronic  pleurisy  we  may  have  recourse  to  the  following  treat- 
ment, that  has  proven  in  a  number  of  instances  most  satisfactory  to 
the  author :  Electric  light  bath  until  free  perspiration ;  circular  rain 
bath  at  105°  F.  for  one  and  one-half  minutes,  reduced  to  60°  F.  for 
one-fourth  minute,  pressure  thirty  pounds.  This  should  be  followed 
by  the  Scottish  jet  or  fan  douche  to  the  affected  side,  the  hot  water 
at  a  temperature  of  105°  to  110°  F.  for  one-half  minute,  cold  from 
70°  to  60°  F.  for  ten  to  fifteen  seconds.  The  number  of  alternations 
should  range  from  two  to  five.  Judgment  must  ,be  exercised  in  the 
use  of  the  Scottish  douche  to  the  chest,  and  it  is  best  in  these  cases  to 
commence  with  the  fan  douche  under  very  moderate  pressure — ten 
to  fifteen  pounds — and  by  gradually  accustoming  the  patient  to  the 
percussory  influence  of  the  douche  reach  the  stimulating  measure  of 
the  jet — under  twenty  to  twenty-five  pounds  pressure. 

In  connection  with  the  treatment  of  chronic  pleurisy  by  hydro- 
therapy much  advantage  will  be  gained  from  the  use  of  those  gym- 
nastics that  have  for  their  object  the  expansion  of  the  thorax  and 
the  activity  of  the  thoracic  muscles.  The  patient  should  be  taught, 
in  addition,  to  frequently  breathe  deeply  through  the  nose,  retaining 
the  air  within  the  chest  so  as  to  stretch  the  chest  wall  thoroughly. 
Associative  measures  of  some  value  in  relieving,  promoting  absorp- 
tion and  preventing  adhesions,  will  be  found  in  the  galvanic  current 
and  massage.  Should  a  purulent  collection  accumulate  excision  of 
the  rib  is  the  proper  procedure,  securing  free  drainage  for  the  pleural 
sack  just  as  we  would  for  any  abscess  cavity.  Iodide  of  potassium, 
(juinine  and  iron  are  good  adjuvants. 


CHAPTER  XIV. 

DISEASES  OF  THE  PERITONEUM  AND  LIVER;  RHEUMA- 
TISM; GOUT;  DIABETES;  OBESITY;  RACHITIS. 

Peritonitis. 

Peritonitis  is  an  inflammation  of  the  peritoneum,  characterized 
by  intense  pain,  tympanites,  vomiting,  fever  and  great  prostration. 
Its  origin  is  usually  microbic.  entrance  being  gained  usually  by  trau- 
matism within  the  bowel,  although  cases  have  been  reported  where 
it  has  been  believed  that  they  have  migrated  through  inflamed  in- 
testinal walls.  Where  ulceration,  perforation  and  rupture  take 
place  the  inflammation  results  from  the  same  causes  that  produce 
the  original  disease.  The  micro-organisms  most  commonly  found 
are  bacillus  coli  communis,  staphylococcus  aureus  and  albus,  bacillus 
pyocyaneus.  tubercle  bacillus  and  the  gonococcus.  This  latter  germ 
usually  gains  entrance  into  the  peritoneum  from  the  Fallopian  tubes. 
The  treatment  is  both  medical  and  surgical,  and  in  the  opinion  of  the 
author  a  surgeon  should  be  at  once  summoned,  as  the  question  of 
operative  procedure  early  in  these  cases  is  a  factor  not  to  be  disputed. 
The  disease  compels  rest  in  bed ;  the  diet  should  be  absolutely  liquid — 
albumen-water,  thin  soups,  gruels  of  arrow  root  or  barley,  dry  cham- 
pagne, etc.  The  patient  should  be  given  salines  until  free  catharsis 
is  secured,  one  to  two  drachms  every  two  to  three  hours.  Vomiting 
is  best  met  by  the  administration  of  pellets  of  ice,  Vichy  water  and 
the  like.  Tympanites  is  often  overcome  by  the  use  of  high  enemata 
of  warm  saline,  to  which  a  little  turpentine  has  been  added.  Where 
the  fever  is  high  the  temperature  of  the  enema  should  be  80°  F. 
Cardiac  weakness,  which  always  accompanies  the  disease,  is  most 
satisfactorily  combated  by  the  systematic  use  of  the  precordial  com- 
press over  which  the  ice-bag  has  been  placed,  being  applied  for  fifteen 
to  twenty  minutes  four  to  five  times  daily.  Hydrotherapy  is  of  some 
service.  A  fomentation  at  115°  to  120°  F.  for  ten  minutes  may  be 
repeated  for  the  same  length  of  time  and  followed  by  the  stimulating 
cold  compress  at  60°  F.  for  thirty  minutes  to  two  hours,  with  an 
ice-bag  or  coil  over  the  region  most  affected,  and  will  sometimes  in- 
crease the  vital  strength  of  the  patient,  reduce  pain  and  cause  a  cessa- 
tion of  vomiting. 

The  author  is  constrained  to  believe,  however,  that  these  are 
280 


DJSEASES  OF  PERITONEUM  AND  LIVER.  281 

more  or  less  temporizing  or  adjunct  procedures,  and  that  surgical 
intervention  is  of  the  most  service  in  this  disease.  In  the  chronic 
form  we  have  to  do  with  an  inflammation  that  is  usually  tuberculous, 
cancerous  or  syphilitic,  and  in  the  management  of  this  most  difficult 
problem  we  should  have  recourse  to  the  sections  in  which  these  dis- 
eases and  their  treatment  are  discussed.  The  dietary  in  the  chronic 
cases  should  be  most  carefully  arranged  to  avoid  as  far  as  possible 
fermentation  and  the  generation  of  gas.  Free  water  drinking  is 
indicated.  We  may  have  recourse  to  enemata  and  mild  laxatives 
to  overcome  any  tendency  to  constipation.  Sometimes  the  foment- 
ation for  fifteen  to  twenty  minutes  three  times  daily,  followed  by  the 
stimulating  cold  compress  well  protected,  gives  some  gratifying  relief. 
During  the  stage  of  convalescence  from  peritonitis  rest  in  bed,  con- 
centrated diet  and  the  gradual  administration  of  tonic  hydrothera- 
peutic  measures,  such  as  the  dripping  sheet  and  the  horizontal  rain 
bath,  may  be  utilized. 

Ascites — Dropsy — Anasarca. 

Ascites  is  a  collection  of  serous  fluid  in  the  peritoneal  cavity 
characterized  by  a  distended  abdomen,  dullness  on  percussion,  fluctua- 
tion and  difficult  breathing.  It  may  collect  in  small  or  enormous 
quantities,  the  author  having  seen  several  cases  in  which  quantities 
have  been  removed  far  in  excess  of  ordinary  belief.  It  usually  has 
back  of  it  a  causative  condition  arising  principally  in  the  heart,  kidney 
or  liver.  Cancer  is  sometimes  its  cause,  and  it  may  be  safely  stated 
that  where  ascites  exists  in  the  presence  of  a  tumor,  and  blood  in  any 
great  quantity  in  the  fluid  aspirated,  points  to  a  diagnosis  of  this 
disease.  It  stands  to  reason  that  ascites,  being  more  or  less  symptom- 
atic, requires  a  consideration  in  its  treatment  of  the  particular  disease 
that  may  be  the  agent  causing  the  condition.  To  accomplish  the  dis- 
appearance of  the  fluid,  diminish  its  secretion  and  stimulate  its  ab- 
sorption, water-drinking  may  prove  useful,  but  its  administration  must 
be  carried  out  on  the  following  lines :  The  free  ingestion  of  cold 
water  is  allowed  and  then  a  period  of  six  or  eight  hours  must  inter- 
vene before  any  other  fluid  is  taken.  Under  this  procedure  it  will  be 
found  that  the  blood  becomes  more  consistent,  more  impoverished 
in  water,  and  therefore  takes  up  water  from  the  tissues  and  abdom- 
inal cavity.  It  is  not  only  true  that  the  administration  of  water  in 
this  way  increases  the  elimination  of  the  liquids  of  the  body,  but  it 
also  carries  with  it  the  solid  products  of  inflammation  and  the  ex- 
udates contained  in  the  fluid.  Cold  water  has  a  direct,  diuretic  effect, 
and  while,  generally  speaking,  water-drinking  is  not  indicated  in 
nephritic  cases,  even  in  these  its  use,  as  above  directed,  will  be  found 
advantageous.  Where  it  is  due  directly  to  cardiac  insufficiency  the 
precordial  compress,  over  which  a  coil  of  cold  water  or  an   ice-bag 


282  PRACTICAL  HYDROTHERAPY. 

has  been  placed,  will  materially  aid  in  the  removal  of  the  effusion. 
In  this  respect  the  ice-bag  has  an  action  analogous  to  digitalis,  raising 
arterial  pressure  and  stimulating  the  circulation.  Hydrotherapy  is 
of  unquestioned  value.  We  may  use  the  hot-air  bath,  electric  light 
bath,  or,  what  is  by  far  the  most  satisfactory  of  all  measures,  super- 
heated dry  hot  air  applied  by  means  of  the  body  apparatus.  The 
patient  should  be  placed  in  this  apparatus  only  as  far  as  the  arm-pits. 
The  temperature  should  range  from  200°  to  300°  F.,  and  the  treat- 
ment from  twenty  to  sixty  minutes.  During  its  application  the  head 
should  be  kept  cold  by  means  of  a  wet  turban  or  ice-cap  and  com- 
press, and  the  ice-bag  placed  over  the  heart.  This  treatment  must 
be  repeated  daily.  In  two  cases  the  author  has  seen  benefit  after  the 
second  bath.  No  cold  applications  are  to  be  made  after  this  treatment 
until  evidence  of  diminution  of  the  dropsy  is  present.  It  is  some- 
times best  to  tap  the  patient  and  follow  the  tapping  with  the  treatment 
here  outlined  to  prevent  reformation.  Where  access  cannot  be  had 
to  the  apparatus  mentioned,  we  may  employ  the  wet  half  pack  from 
the  arm-pits  down  at  a  temperature  of  70°  F.  for  one  to  two  hours, 
repeated  twice  daily.  The  abdominal  compress  at  65°  F.,  or  circular 
compress  to  the  limbs  and  swollen  parts,  will  oftentimes  prove  of 
considerable  value  as  a  means  of  giving  comfort  and  relief  to  the 
patient.  The  pack  and  compress  may  be  combined,  giving  the  pack  at 
65°  to  70°  F.  for  an  hour,  and  in  the  interim  applying  abdominal 
and  circular  compresses  at  65°  F.  to  the  affected  parts.  Sometimes 
friction  with  a  dry  cloth  alone  will  stimulate  absorption,  but  in  any 
event  it  should  be  utilized  after  the  hydriatic  measures  suggested. 
It  will  usually  be  found  that  these  treatments  result  in  increased 
power  and  diminished  work  on  the  part  of  the  organs  affected.  We 
find  that  the  heart  is  invigorated,  its  systole  strengthened,  its  diastole 
lengthened,  with  a  better  pulse  and  an  increased  arterial  tension,  due 
to  better  muscular  state  in  itself  and  in  the  arteries. 

As  convalescence  takes  place  we  may  in  these  cases  institute 
carbon  dioxide  baths  or  tonic  procedures  as  follows :  Hot-air  or 
electric  light  bath  to  perspiration,  followed  by  the  dripping  sheet  at 
70°  F.  for  three  minutes  with  vigorous  friction,  reducing  the  tem- 
perature one  degree  daily  until  60°  F.  is  reached.  At  this  time  we 
may  institute  the  electric  light  bath  to  free  perspiration,  followed  by 
the  circular  or  horizontal  rain  bath  at  105°  F.  for  one  and  one-half 
minutes,  reduced  to  70°  F.  for  one-half  minute,  pressure  twenty 
pounds.  Diminish  temperature  one  degree  daily  until  60°  F.  is 
reached  and  increase  pressure  one  pound  daily  until  thirty  is  regis- 
tered. Later  we  may  add  to  this  treatment  the  Scottish  douche  at 
110°  F.  for  twenty  seconds,  followed  by  a  temperature  of  60°  F. 
for  five  seconds,  three  alternations,  applied  to  the  lower  spine  and 
legs. 


DISEASES  OF  PERITONEUM  AND  LIVER.  283 

Hepatic  Congestion. 

This  condition  of  so-called  "biliousness"  is  an  abnormal   fullness 
or  engorgement  of  the  vessels  of  the  liver,  characterized  by  disorder 
of  the  digestive   functions,  sallow  color,  coated  tongue,   foul  breath 
and  mental  torpor.     The  liver  is  usually  tender  to  palpation.     This 
condition    originates    most    frequently    in    the    disobedience    of    those 
hygenic  laws  that  all  should  follow,  is  brought  about  by  errors  and 
excess    in    eating    and    drinking,    especially    where    malt    or    alcoholic 
liquors   are   added    to   the   excessive    food.      Chronic   indigestion   and 
habitual   constipation  are  causes  that  are  exceedingly  common,  and 
demand  consideration  at  all  times  by  the  hydriatist  in  his  manage- 
ment of  these  cases.    The  aim  should  be  to  overcome  the  acute  attack 
and  prevent    its    return.        During   the   attack   we   may   administer   a 
pretty  good  dose  of  calomel  and  follow  it  with  a  saline,  but  should 
the  patient  remain  very  much  upset  a  more  rapid   way  of  relief  is 
to  wash  the  stomach,  removing  all  fermenting  material;  also  giving 
a  high  enema  of  soap  and  water.       After  this  much  relief  will  be 
gained    from    the    application   of    the    fomentation,    repeated   as    fre- 
quently  as   is   necessary.      It   may   be   confidently   stated   that   where 
the    congestion     is    not    due   to    organic    changes    hydrotherapy    is 
a    most    efficient    method    for    permanent    relief.      These    cases    are 
usually   more   or   less    robust,   and   we   may   at   once   commence   the 
admininstration  of  full  treatment.     Give  the  electric  light  bath  or  hot- 
air  bath  until   free  perspiration  takes  place,   following  this  with  the 
horizontal  or  circular  rain  bath  at   105°    F.   for    one    and    one-half 
minutes,   reduced   to   70°    F.    for   one-half    minute,   pressure  twenty 
pounds.     Increase  pressure  one  pound  daily  until  thirty  is  registered. 
At  this  time  we  may  place  these  cases  on  the  following  very  active 
treatment :  Electric  light  bath  or  hot-air  bath  until  free  perspiration ; 
circular  or  horizontal  rain  bath  at  105°  F.  for  one  and  one-half  min- 
utes;  fan  douche  over  the  liver  and  abdomen,  jet  douche  to  the  spine 
for   one-fourth   minute   each,   temperature   70°    F.       Commence  the 
pressure  at  fifteen  to  twenty  pounds  and  gradually  increase  to  thirty; 
reduce  temperature  one  degree  daily  until  60°  F.  is  reached.     Should 
constipation  be  present   recourse  should  be  had  to  the  dietary  and 
general   measures   suggested  under   that   head.        In  these   cases   the 
Turkish  bath  has  won  for  itself  a  reputation  that  is  well  justfied,  and 
the  only  regret  is  that  these  baths  are  not  more  frequently  under  the 
charge  of  intelligent  people  who  could  administer  them  suited  to  the 
individual  case.     Where  intelligently  and  carefully  applied  the  writer 
can  testify  to  the  benefit  to  be  derived  from  them  by  sufferers  from 
this  condition. 


284  PRACTICAL  HYDROTHERAPY. 

Catarrhal  Jaundice. 

Icterus  is  not  a  disease,  but  a  symptom-complex  group,  of  an 
acute  catarrhal  inflammation  of  the  mucous  membrane  of  the  bile- 
ducts,  and  characterized  by  gastro-intestinal  derangements,  fever, 
mental  depression  and  sallowness  of  the  skin.  While  these  cases  are 
not  generally  considered  obstructive,  still  they  are  in  all  probability 
more  or  less  so.  The  patient  should  at  once  be  put  in  bed  and  placed 
at  rest  and  the  diet  limited  to  liquids,  of  which  milk  and  lime-water, 
milk,  peptonized  milk,  buttermilk,  whey,  raw  eggs  and  broths  of  beef, 
chicken,  etc.,  are  the  type.  As  improvement  takes  place  we  may  add 
milk  toast,  arrow  root,  boiled  rice,  oysters,  meat  jellies,  fish,  scraped 
meat,  squab,  chicken  and  soft-boiled  eggs.  Little  sugar,  fats  and 
starches  should  be  eaten.  Free  hot-water  drinking  is  essential,  and 
with  this  we  may  utilize  the  Carlsbad  water,  as  suggested  by  numerous 
authors,  two  glasses  of  which  may  be  drunk  at  least  half  to  three- 
quarters  of  an  hour  before  breakfast.  It  is  of  comparatively  little 
value,  except  for  the  relief  of  the  intestinal  condition.  The  Rock- 
bridge alum  water  sometimes  acts  better.  Local  treatment  to  the 
bowel  is  oftentimes  of  great  service,  especially  high  enemata  of  cold 
water  two  or  three  times  daily,  using  about  one  quart  of  water  at  a 
temperature  from  60°  to  65°  F.  Small,  very  cold,  low  enemata  at 
50°  F.  twice. daily,  or  a  small  piece  of  ice  introduced  into  the  rectum, 
are  of  undoubted  value,  causing  a  freer  flow  of  bile  and  a  relief  of 
the  inflammatory  condition  through  reflex  influence  upon  the  upper 
intestine  and  gall-bladder.  Where  there  is  much  pruritus  we  may 
employ  the  very  hot  sponge  at  110°  to  120°  F.,  to  the  water  of  which 
sodium  bicarbonate,  three  drachms  to  the  pint,  has  been  added. 
Especially  valuable  in  this  connection  is  the  neutral  bath  to  which 
sufficient  sodium  bicarbonate  or  potassium  carbonate  has  been  added 
to  render  it  alkaline.  Where  much  pain  exists  we  may  apply  the 
very  hot  fomentation  (120°  to  130°  F.)  for  ten  minutes,  immedi- 
ately repeated  for  ten  minutes  and  followed  by  the  abdominal  com- 
press at  60°  F.,  worn  for  three  hours,  at  the  end  of  which  time  we 
may  again  repeat  the  process.  As  soon  as  the  patient  is  able  to  stand 
tonic  measures  they  should  be  instituted.  Commence  with  the  drip- 
ping sheet  at  70°  F.  for  three  minutes,  with  vigorous  friction,  followed 
by  the  cold  sitz  bath  at  60°  to  65°  F.  for  five  to  ten  minutes.  As 
soon  as  reactive  capacity  is  established  we  may  commence  with  the 
electric  light  bath  or  hot-air  bath  until  free  perspiration  takes  place, 
followed  by  the  dripping  sheet  at  60°  F.  and  the  sitz  bath  as  above 
described.  After  a  few  days'  treatment  we  may  then  try  the  following 
treatment,  which  has  proved  very  satisfactory  in  the  hands  of  the 
author:  The  electric  light  bath  or  hot-air  bath  until  free  perspira- 
tion takes  place,   followed  by  the  circular  or  horizontal  rain  bath  at 


DISEASES  ()/■'  PERITONEUM  AND  LITER.  285 

105°  F.  for  one  minute  and  a  half,  this  to  be  followed  by  the  fan 
douche  to  the  entire  body  and  the  jet  douche  over  the  liver  region. 
The  pressure  should  be  started  low — fifteen  pounds — and  gradually 
increased  daily  until  twenty-five  or  even  thirty  pounds  is  registered. 
The  fan  and  jet  douche  may  be  commenced  at  a  temperature  of 
70°  F.,  reduced  one  degree  daily  until  60°  F.  is  reached.  To  this 
treatment  every  other  day,  or,  what  is  more  preferable,  at  some  other 
time  during  the  day,  may  be  added  the  sitz  bath  at  60°  to  65°  F.  for 
five  minutes. 

Cholelithiasis;  Acute  Infectious  Cholecystitis;  Cholangitis. 

Biliary  calculi,  hepatic  colic,  usually  originate  from  concretions  in 
the  gall-bladder  or  biliary  ducts.  These  stones  are  formed  partly  or 
entirely  from  the  constituents  of  the  bile,  and  their  presence  is  not 
recognized  until  they  attempt  to  pass  from  the  gall-bladder  through 
the  common  duct  into  the  intestine,  the  result  of  which  passage  is  an 
attack  of  colic.  Bacteria  act  as  causative  agents  by  producing  inflam- 
mation, and  in  the  case  of  cholecystitis  the  origin  is  strictly  bacteric. 
The  stones  are  brown,  spherical,  ovoid  or  polygonal,  their  particular 
constituent  being  cholesterin.  They  may  become  a  cause  of  other 
troubles,  such  as  perforation,  suppuration,  peritonitis  and  hepatic 
abscess.  The  rule  is  that  uncomplicated  cases  recover.  During  the 
attacks  we  may  apply  the  very  hot  fomentation  (130°  to  140°  F.), 
followed  by  the  very  hot  compress  for  twenty  to  thirty  minutes,  re- 
peating these  as  often  as  necessary  to  gain  relief.  Some  writers 
have  found  the  hot  full  bath,  as  hot  as  can  be  borne,  an  excellent 
method  by  means  of  which  the  patient  may  be  relaxed  and  the  pain 
relieved.  An  excellent  method  is  the  use  of  the  hot  trunk  compress 
with  the  hot-water  coil  or  bag  upon  the  outside  to  maintain  the 
temperature.  The  patient  may  be  instructed  to  drink  freely  of  very 
hot  water.  Should  this  be  vomited  the  drinking  must  be  continued, 
as  it  will  tend  to  allay  vomiting  and  stop  the  pain.  During  the 
intervals  we  may  continue  the  use  of  free  water-drinking  and  the 
administration  before  breakfast  of  sodium  phosphate  or  Carlsbad 
water. 

The  experience,  however,  of  the  last  two  or  three  years  seems  to 
indicate  that  it  is  possible  to  remove  calculi  in  the  most  difficult  cases 
with  comparative  safety,  provided  the  patient  be  not  allowed  to  become 
too  much  poisoned  by  intestinal  toxins,  the  toxins  of  the  bile  and 
those  resulting  from  membranous  infection.  It  may  therefore  be 
considered  that,  given  a  reasonable  certainty  of  gall-stones,  we  may 
employ  the  knife,  as  the  operation  is  fairly  safe.  Operation  does  not, 
however,  insure  against  the  reformation  of  gall-stones.  It  simply 
removes  existing  stones,  cleanses  the  ducts,  and  favors  free  exit  of 
the  bile.     For  this  reason  we  should,  during  convalescence,  and  for 


286  PRACTICAL  HYDROTHERAPY. 

many  months  after  an  operation  for  biliary  calculi,  place  the  patient 
upon  treatment  that  will  have  for  its  object  the  restoration  of  the 
general  health,  the  increase  of  vital  resistance,  the  prevention  of 
stagnation  of  the  bile  and  better  general  intestinal  conditions.  The 
diet  at  this  time  should  be  such  as  to  avoid  farinaceous  and  fatty 
foods,  at  the  same  time  eliminating  vinegar,  spices,  pastry,  tea,  coffee, 
alcohol,  etc.  The  correction  of  sedentary  habits  should  be  insisted 
upon.  The  three  best  exercises,  in  my  opinion,  are  horseback  riding, 
bicycling  and  bowling.  These  exercises  involve  the  activity  of  the 
abdominal  muscles,  which  by  their  movement  tend  to  act  as  a  suction- 
pump  in  removing  the  thickened  biliary  secretions. 

Here  again  we  should  insist  upon  the  free  ingestion  of  water.  Two 
tumblers  of  Carlsbad  water  at  140°  to  150°  F.  before  breakfast  and 
free  drinking  of  plain  water  during  the  day  must  be  insisted  upon. 
These  cases,  after  operation,  are  usually  much  prostrated,  and  need 
a  continuous  up-building  for  long  periods  of  time,  and  nowhere  in 
the  range  of  therapeutics  will  be  found  a  better  method  than  hydro- 
therapy. Commence  with  the  dripping  sheet  at  80°  F.  for  three 
minutes,  with  friction,  taking  care  to  have  the  patient  stand  in  a 
foot-tub  of  hot  water  during  its  application.  Reduce  the  temperature 
one  degree  daily  until  70°  F.  is  reached.  At  this  time  the  patient's 
reactive  capacity  will  enable  us  to  proceed  to  the  next  step: — the 
electric  light  bath  or  hot-air  bath  to  free  perspiration,  followed  by 
the  circular  or  horizontal  rain  bath  at  105°  F.  for  two  minutes,  re- 
duced to  70°  F.  for  one  minute,  pressure  twenty  pounds.  Decrease 
temperature  one  degree  daily  until  60°  F.  is  reached  and  increase 
pressure  one  pound  daily  until  thirty  is  registered.  If  any  discomfort 
is  felt  over  the  site  of  the  operation  have  the  patient  protect  the 
same  with  the  hand.  At  this  stage  give  the  electric  light  bath  or  hot 
air  bath  until  free  perspiration,  followed  by  the  circular  or  horizontal 
rain  bath  at  105°  F.  for  one  and  one-half  minutes,  this  in  turn  to  be 
followed  by  the  fan  douche  to  the  entire  body  and  the  jet  douche  to 
the  liver  at  70°  F.  for  one-fourth  minute  each.  The  pressure  in  this 
treatment  should  be  started  low — fifteen  pounds — and  very  gradually 
increased  until  twenty  to  twenty-five  pounds  is  registered.  The  tem- 
perature may  be  reduced  one  degree  daily  until  60°  F.  is  reached. 
Adjunct  measures  that  will  be  found  of  distinct  value  in  these  cases 
arc  the  use  of  massage  and  the  application  of  the  static  wave  current 
over  the  hepatic  region.  A  combination  of  these  measures  sometimes 
produces  astonishing  results. 

Hepatic  Cirrhosis. 

Cirrhosis  of  the  liver  is  an  inflammation  of  the  connective  tissue 
of  that  organ,  chronic  in  its  progress,  producing  induration,  followed 
by  atrophy  of  the  liver  cells,  characterized  by  slight  jaundice,  emacia- 


DISEASES  OF  PERITONEUM  AND  LIVER.  JX7 

tion,  gastrointestinal  catarrh  and  ascites.  The  causative  factor  of 
the  disease  is  generally  the  long-continued  and  daily  use  of  alcohol, 
although  the  method  of  its  action  upon  the  liver  connective  tissue  is 
unknown.  It  would  seem  from  recent  investigations  and  experience 
that  alcohol,  with  its  disturbing  influence  upon  the  stomach  and  in- 
testine, generates  a  favorite  nidus  for  toxins.  If  this  be  true — and 
it  is  now  most  generally  accepted  to  be  true — treatment  in  the  early 
stage  should  be  very  effective  in  the  arrest  and  prevention  of  the 
disease.  Xo  claim,  of  course,  can  be  made  for  the  removal  of  cirrhotic 
tissue,  but  functional  activity  may  be  preserved  and  symptomatic 
cure  obtained.  The  patient  should  be  instructed  to  live  as  much  as 
possible  an  out-door  life,  and  to  exercise  along  those  lines  that  will 
most  influence  the  abdominal  and  trunk  muscles.  For  this  reason 
horseback  riding,  rowing,  bowling  and  gymnastic  movements  for  the 
trunk  are  very  valuable.  The  diet  should  consist  of  bouillon,  soups, 
milk,  custard,  vegetables,  such  as  string  beans,  peas,  potatoes,  mashed 
or  baked,  lettuce,  tomatoes,  turnips,  spinach,  greens,  etc.  Meats 
should  be  eaten  in  great  moderation,  the  white  ones  being  preferred, 
especially  chicken,  squab,  turkey,  fish,  etc.  All  forms  of  alcohol, 
together  with  spices,  teas,  coffee,  fried  food,  pastry,  etc.,  should  be 
interdicted.  Especial  care  should  be  taken  to  maintain  an  equable 
body  heat  and  the  avoidance  of  cold  and  fatigue.  Water  may  be 
freely  drunk,  especially  the  alkaline  and  alkaline  carbonated  waters, 
Carlsbad  water  before  breakfast,  very  hot,  or  some  form  of  saline 
purgative,  is  useful.  In  case  of  ascites  tapping  should  be  done.  In 
this  disease  the  electric  light  bath  seems  to  exercise  a  very  beneficent 
action  and  oftentimes  is  of  surprising  benefit.  In  this  respect  it 
resembles  the  sun  bath,  with  regard  to  which  clinical  observations 
have  shown  it  to  be  a  powerful  factor  in  degenerative  conditions  in 
abdominal  viscera.  The  arc  light  bath,  especially  where  concentrated 
over  the  liver,  is  an  excellent  method  of  treatment,  and  may  be  com- 
bined, if  so  desired,  in  simultaneous  use  with  the  electric  light  bath. 
Commence  the  treatment  with  the  electric  light  bath  to  free  perspira- 
tion, followed  by  the  rain  bath  at  105°  F.  for  one  and  one-half 
minutes,  reduced  to  70°  F.  for  one-half  minute,  pressure  twenty 
pounds.  Decrease  the  temperature  one  degree  daily  until  60°  F.  is 
reached  and  increase  pressure  one  pound  daily  until  thirty  is  regis- 
tered. This  should  be  followed  by  the  cold  sitz  bath  at  50°  to  60°  F. 
for  five  minutes.  As  soon  as  the  patient  reacts  well  we  may  proceed 
to  the  following  full  treatment:  Electric  light  bath  to  free  perspira- 
tion, followed  by  the  circular  or  horizontal  rain  bath  at  105°  F.  for 
one  and  one-half  minutes,  followed  by  the  fan  douche  to  the  entire 
body  for  one-fourth  minute  and  the  jet  douche  over  the  liver  for 
one- fourth  minute.  The  fan  and  jet  douche  should  be  commenced 
under  low  pressure — ten  to  fifteen  pounds — and  daily  increased  until 


288  PRACTICAL  HYDROTHERAPY. 

twenty  or  twenty-five  pounds  is  registered.  The  temperature  should 
start  at  70°  F.  and  be  reduced  one  degree  daily  until  60°  F.  is 
reached.  There  is  no  question  whatsoever  that  the  cold  jet  douche 
is  one  of  the  most  powerful  and  effective  means  of  stimulating  the 
liver.  It  increases  its  circulation  and  functional  activity,  but  before 
these  effects  are  noticeable  it  must  reach  a  point  of  considerable 
pressure.  In  some  cases  we  may  advantageously  terminate  the  treat- 
ment with  the  Scottish  douche  over  the  liver,  especially  if  any  pain 
is  experienced.  The  temperatures  of  the  Scottish  douche  should 
range  between  110°  F.  for  thirty  seconds  and  60°  F.  for  five  to  ten 
seconds,  alternating  three  to  four  times.  In  cases  that  are  feeble  or 
confined  to  the  bed  the  fomentation  applied  over  the  liver  will  some- 
times give  great  comfort  and  relief  even  in  advanced  cases.  It  should 
be  followed  by  the  cold  compress. 

In  this  disease  the  author  would  again  recommend  the  added  use 
of  massage,  static  sparks  over  the  liver  and  the  galvanic  current. 

Acute  Articular  Rheumatism. 

Rheumatic  fever  is  a  constitutional,  migratory  disease,  charac- 
terized by  fever,  non-suppurative  inflammation  in  and  around  the 
joints,  acid  sweating,  and  a  tendency  to  inflammation  of  the  endo- 
and  pericardium.  The  origin  of  the  disease  is  supposed  to  be  a 
micro-organism,  probably  a  diplococcus,  infectious  in  character,  al- 
though the  germ  has  not  as  yet  been  successfully  isolated  and  cul- 
tivated. There  is  no  question  but  what  exposure  to  damp,  cold,  and 
sudden  changes  in  the  atmosphere,  especially  in  those  who  are  of 
lowered  vitality,  tend  to  produce  the  disease.  It  is  rare  in  the  ex- 
tremes of  infancy  and  old  age.  It  is  essentially  an  exudative  in- 
flammation in  synovial  membranes  and  ligamentous  tissues.  There 
is  an  increased  quantity  of  lactic  acid  present  in  the  system,  but  the 
exact  relation  of  this  as  to  cause  and  effect  is  unknown.  The  fever, 
usually  102°  to  104°  F.,  in  some  cases  is  raised  to  108°  to  110°  F., 
constituting  the  dangerous  rheumatic  hyperpyrexia,  at  which  time 
cerebral  symptoms  of  delirium  are  usually  present.  It  is  prone  to 
attack  joints  on  the  same  side  of  the  body.  Rheumatism  per  se 
is  not  a  dangerous  disease,  the  danger  arising  from  inflammations 
of  the  cardiac  membranes.  There  is  no  tendency  on  the  part  of 
rheumatism  toward  recovery,  and  relapses  are  frequent.  The  mor- 
tality is  very  low,  ranging  from  0.3  to  0.5  per  cent.,  recovery  being 
the  rule.  Treatment  should  have  for  its  object  four  purposes : '(1) 
Combat  the  inflammation.  (2)  encourage  elimination.  (3)  relieve 
pain,  and  (4)  prevent  cardiac  and  cerebral  complications.  These 
indications  are,  in  my  opinion,  best  met  by  the  combined  use  of  hygiene, 
hydrotherapy  and  the  salicylates. 

The  patient  should  at  once  be  placed  in  bed  at  absolute  rest.     The 


RHEUMATISM.  289 

garment  de  unit  must  be  woolen,  and  the  patient  lie  as  far  as  pos- 
sible between  blankets  and  avoid  the  use  of  sheets.  The  bed-clothing 
should  be  only  sufficient  to  keep  him  warm,  and  should  the  inflamed 
joints  be  excessively  tender  they  may  be  protected  by  specially  con- 
structed framework.  The  diet  must  be  absolutely  liquid,  milk  keep- 
ing a  prominent  place,  to  which  may  be  added  Vichy  or  seltzer 
waters.  The  free  use  of  water  is  to  be  encouraged,  as  much  as  one 
gallon  in  the  twenty-four  hours  being  taken.  With  some  persons 
this  is  difficult,  but  by  flavoring  it  with  orange,  lemon,  raspberry  or 
other  fruit  juices,  it  is  easily  accomplished.  If  sweetening  is  de- 
manded, use  saccharine,  for  all  cane  sugars  and  proteid  food  must 
be  avoided. 

After  many  years'  experience  in  the  use  of  the  various  forms 
of  salicylic  acid,  I  have  practically  limited  myself  to  the  use  of 
sodium  salicylate,  aspirin  and  salophen.  These  alone,  or  combined 
with  small  doses  of  strychnia,  are  prescribed  in  rapidly  increasing 
doses  until  the  physiological  effect  is  obtained,  and  which,  in  my 
opinion,  should  be  maintained  until  the  subsidence  of  the  disease. 
Salicylates  act  a  great  deal  as  quinine,  and  by  some  are  considered 
an  absolute  specific.  Heat  is  an  essential  method  of  treatment  to 
obtain  results  in  acute  articular  rheumatism.  In  private  practice, 
where  the  practitioner  has  no  access  to  special  apparatus,  we  may 
employ  the  full  dry  pack.  The  night  garment  should  be  removed, 
the  blankets  warmed  and  the  patient  enveloped  in  them,  where  he  is 
to  remain  until  perspiration  takes  place.  Where  we  have  access  to 
the  incandescent  light  we  may  use  the  general  application  or  local 
electric  light  bath  applied  to  the  inflamed  joints.  In  sanatorium  prac- 
tice there  is  nothing  comparable  to  the  use  of  superheated  dry  hot 
air  at  temperatures  ranging  from  200°  to  325°  F.  for  the  entire  body, 
or  300°  to  400°  F.  for  the  local  application  to  a  single  joint.  These 
applications  are  all  absolutely  harmless,  and  fulfill  the  four  indica- 
tions of  combating  the  inflammation,  increasing  elimination,  reliev- 
ing the  pain  and  preventing  complication.  There  is  no  question  but 
what  the  very  great  cutaneous  activity  induced  aids  in  the  elimination 
of  the  lactic  acid  and  other  waste  products  found  in  the  body.  If 
at  the  same  time  the  patient  is  drenched  with  water  internally,  we 
will  find  that  during  the  application  the  perspiration  is  more  profuse 
and  elimination  through  the  kidney  better.  With  the  dilating  of 
the  surface  vessels  and  the  profuse  perspiration,  heat  elimination 
will  be  favored  and  temperature  lowered.  The  action  of  heat,  gen- 
eral and  local  raises  the  temperature  of  the  blood  one  or  two  de- 
grees, and  this  seems  to  be  the  therapeutic  factor.  It  has  often 
seemed  to  me  that  it  was  a  true  bactericide.  The  heat  certainly 
favors  vascular  activity,  reduces  the  local  congestion,  stimulates 
metabolism,   increases   elimination,   relieves   pain   and   destroys   those 


290  PRACTICAL  HYDROTHERAPY. 

products  that  are  likely  to  produce  complications.  It  will  be  noticed 
by  patients  that  the  profuse  diaphoresis  is  promoted  without  head- 
ache, but  it  is  always  advisable,  in  administering  the  above  treat- 
ments, to  place  a  cold  cloth  upon  the  patient's  forehead,  unless  there 
is  some  rheumatic  involvement  of  the  scalp.  After  all  treatments 
of  this  character,  the  patient  must  be  removed  and  wrapped  in 
blankets,  where  he  is  to  remain  for  several  hours.  In  the  use  of  a  local 
incandescent  electric  light  bath  in  bed,  whether  it  be  general  or  local,  the 
bed  should  be  so  prepared  as  to  enable  the  nurse  to  immediately  wrap 
the  patient  in  blankets  upon  removing  the  apparatus,  and  thus  prevent 
chilling. 

Where  the  general  or  local  superheated  dry  hot  air  apparatus 
has  been  used,  the  patient  should  be  placed  in  bed  without  re- 
moving the  Turkish  bath-robe,  mittens  or  stockings  in  which  he  has 
been  enveloped.  As  soon  as  perspiration  ceases,  the  nurse  carefully 
dries  the  patient  with  warm  towels,  avoiding  exposure  and  chilling. 
Some  cases  are  so  sensitive  that  no  attempt  should  be  made  to  move 
them,  because  of  the  exquisite  suffering  that  is  caused  by  the  slightest 
movement.  When  none  of  the  above  methods  are  accessible,  we 
may  place  the  patient  in  the  hot  full  pack  and  at  the  same  time  apply 
very  hot  fomentations  (160°  F. )  to  the  joints.  By  exercising  a 
little  care  the  pack  may  be  cautiously  opened  and  *he  fomentation 
placed  upon  the  joint.  As  soon  as  the  tenderness  in  the  joints  sub- 
sides somewhat,  we  may  apply  a  stimulating  compress  to  them,  wrung 
out  of  a  saturated  watery  solution  of  common  or  sea  salt  at  60°  F., 
and  allow  same  to  remain  until  dry.  Some  recommend  the  addi- 
tional use  of  oil  silk  or  rubber  tissue  to  prevent  rapid  evaporation. 
In  an  extended  practice  I  have  seen  this  treatment  give  immediate 
relief  to  pain  that  had  been  merely  obtunded  by  opiates,  which  should 
never,  if  possible,  be  administered  in  these  diseases.  Prevention  of 
complications  is  best  met  by  the  heating  and  sweating  procedures 
above  mentioned,  as  they  promote  the  activity  of  the  skin  and  kidney 
and  at  the  same  time  eliminate  the  poison  likely  to  injure  heart  o>- 
brain. 

Hyperpyrexia,  though  a  rare  complication,  may  occasionally  de- 
velop. If  there  is  the  slightest  tendency  toward  an  increased  eleva- 
tion of  temperature  above  104.5°  to  105°  F.,  or  the  presence  of  any 
nervous  symptoms,  the  cold  cephalic  compress  should  be  applied  to 
the  head,  or  the  cold  cephalic  coil  or  ice-cap  may  be  used.  If  this  is 
not  sufficient,  apply  the  hot  full  pack  until  perspiration  takes  place, 
followed  by  the  cold  sponge,  exposing  only  a  portion  of  the  body 
at  a  time.  Should  the  temperature,  however,  continue  to  rise  above 
104.5°  F.,  we  may  have  recourse  to  the  full  bath  at  94°  F.,  gradu- 
ally reduced  to  80°  F.,  using  friction  during  its  application,  and  keep- 
ing the  ice-cap  or  coil  upon  the  head.     Xo  medicines  are  of  any  value 


RHEUMATISM.  291 

in  this  condition,  and  the  physician  should  never  hesitate,  but  use 
the  full  bath  at  once  if  he  desires  to  avoid  fatal  outcome.  In  this 
respect  these  cases  resemble  those  of  insolation.  Where  the  pulss 
indicates  cardiac  weakness,  or  the  ear  detects  threatened  complication, 

it  is  well  to  apply  the  ice-bag  to  the  precordia.  I  am  satisfied  that 
the  more  frequent  use  of  the  ice-bag  would  prevent  these  compli- 
cations. Sufferers  from  this  disease  are  apt  to  be  left  in  a  most 
anemic  condition,  and  in  many  instances  I  have  seen  disagreeable 
cases  of  neurasthenia  develop,  the  treatment  of  which  will  be  found 
in  another  section. 

Convalescence  demands  considerable  care  and  thought.  Moderate 
doses  of  the  salicylates,  combined  with  alkalies,  should  be  continued, 
and  at  the  same  time  tonics  of  iron,  quinine,  strychnine,  glycero- 
phosphates, etc.,  administered.  The  rheumatic  should  be  gradually 
and  systematically  trained  until  tonic  hydriatic  measures  have  been 
attained.  From  a  practical  experience  of  eighteen  years.  I  feel 
satisfied  that  the  frequent  use  of  cold  water  will  do  more  toward 
protecting  these  cases  from  relapse  than  any  other  known  form  of 
treatment.  The  tonic  measures  to  be  employed  should  commence 
with  the  dripping  sheet  at  90°  F..  the  temperature  gradually  reduced 
until  70°  F.  is  reached.  At  this  time  we  may  employ  the  superheated 
dry  hot  air,  the  incandescent  electric  light  bath,  dry  hot  air  or  vapor 
bath,  followed  by  the  rain  bath  at  102°  F.  for  one  and  one-half  min- 
utes, reduced  to  65°  F.  for  ten  to  fifteen  seconds,  to  which  may  be 
later  added  douches,  especially  the  Scottish  douche,  to  those  joints 
that  have  been  affected,  at  110°  to  115°  F.  for  twenty  to  thirty  sec- 
onds, reduced  to  60°  F.  for  five  to  ten  seconds,  four  or  five  alterna- 
tions. 

The  cardiac  complications  are  best  met  by  the  method  known  as 
the  "Schott  system,"  consisting  of  the  artificial  Nauheim  baths  and 
graduated  exercises. 

Chronic  Articular  Rheumatism. 

Chronic  articular  rheumatism1  is  an  afebrile  chronic  affection, 
characterized  by  stiff  and  painful  joints.  I  mean  a  disease  in  which 
the  capsule  and  ligaments  of  the  joint  and  tendon  sheaths  adjacent 
to  the  affected  articulation  are  thickened,  and  in  which  the  principal 
and  conspicuous  symptoms  are  pain  and  stiffness  in  movement  of 
the  affected  joint.  These  conditions  are  found  mostly  after  the 
middle  period  of  life,  and  in  those  who  engage  in  the  laborious  hard- 
ships of  manual  labor,  exposed  to  cold  and  dampness.  They  are 
the  people  who  have  creaking  and  cracking  joints  due  to  dryness 
and  roughness  of  the  articular  surfaces.  This  disease  is  usually 
compatible  with  a  fair  degree  of  health,  although  I  have  seen  many 
sad  cases  of  extreme  disturbance  result  from  the  affection.     The  mo**- 


292  PRACTICAL  HYDROTHERAPY. 

tality  is  practically  nil,  and  the  disease  is  usually  resistant  to  ordinary 
remedial  measures.  It  is  in  this  field  that  hydrotherapy  has  made 
some  of  its  most  brilliant  cures.  Most  of  the  patients  are  unable 
financially  to  remove  to  a  climate  free  from  cold  and  dampness,  and 
for  that  reason  demand  treatment  at  home.  They  are  not  benefited 
by  anti-rheumatic  remedies  or  diet,  but  should  be  liberally  fed  on  a 
diet,  in  my  opinion,  in  which  meat  is  not  entirely  excluded,  but  used 
in  moderation.  Fats  must  be  liberally  administered,  and  to  this  end 
butter,  milk,  sevetol,  buttermilk,  Russell's  emulsion  of  mixed  fats 
are  valuable.  Cereals,  fruits,  vegetables,  moderate  amounts  of  sweets 
and  well-cooked  bread  should  constitute  the  dietary.  I  rarely  ever 
use  anything  else  except  tonics.  Hydriatic  measures  offer  an  excel- 
lent means  of  combating  the  disease,  and  should  have  for  their  object 
the  relief  of  the  pain  and  the  increasing  of  general  vital  resistance. 
Home  treatment  is  often  of  great  value.  A  hot  full  bath  at  night, 
followed  by  the  full  dry  pack  for  one  hour,  will  oftentimes  mitigate 
the  pain  and  secure  restful  sleep.  Where  this  cannot  be  carried  out 
— and  this  is  frequently  the  case  in  private  homes — fomentations  may 
be  applied  to  the  affected  joint.  Where  this  is  not  accessible,  the 
stimulating  compress  applied  to  the  affected  joint,  covered  with  flan- 
nel and  oil  silk,  is  oftentimes  productive  of  satisfactory  results.  Here 
again  we  may  employ  the  compress  dipped  in  a  saturated  watery  solu- 
tion of  common  or  sea  salt,  at  a  temperature  of  65°  F.,  allowing 
same  to  remain  on  all  night. 

With  institutional  facilities  nothing  is  comparable  to  the  use  oc 
superheated  dry  hot  air.  Where  the  condition  affects  a  large  number 
of  joints  it  is  best  to  use  the  full  body  apparatus,  commencing  with 
twenty  minutes  at  200°  F.,  gradually  increasing  the  time  to  one  hour 
and  the  temperature  to  300°  and  350°  F.,  being  careful  to  keep  the 
head  cool  by  means  of  the  turban,  cold  compress  or  ice-cap.  Where 
a  single  joint  or  two  are  affected,  the  local  or  small  joint  apparatus 
should  be  used,  and  the  temperature  raised  to  400°  F.,  same  dura- 
tion. The  Turkish  bath,  Russian  bath  and  hot  vapor  bath  have  all 
been  found  useful,  but  in  my  experience  not  so  valuable  as  the  first- 
named  treatment.  Many  spas  have  won  their  reputation  on  the  treat- 
ment of  this  affection  by  hot  alkaline  or  other  mineral  waters,  notable 
among  which  are  the  hot  springs  of  Virginia  and  Arkansas,  and 
Mount  Clemens,  Mich.  In  Europe,  mud,  sand,  peat  and  mineral 
baths  have  been  used,  but  none  possess  any  therapeutic  value  because 
of  the  animal  or  mineral  matter  contained  in  the  springs.  Hydro- 
therapy must  be  persistently  and  thoroughly  applied  if  permanent 
results  are  desired.  The  final  aim  of  this  treatment,  however,  is  to 
train  the  patient  to  stand  tonic  cold  procedures,  and  as  soon  as  the 
pain  is  partially  relieved  graduated  cold  bathing  should  be  used.  To 
this  end  we  may  start  with  the  cold  sponge,  move     to  the  dripping 


RHEUMATISM.  293 

sheet,  and  finally  utilize  the  more  active  tonic  measures  of  the  ram 
bath  and  douches.  The  Scottish  douche,  in  connection  with  super- 
heated dry  hot  air,  has  proven  in  my  hands  the  most  satisfactory  of 
all  methods.  As  soon  as  the  pain  begins  to  subside  the  patient  should 
be  trained  to  the  Scottish  douche  and  encouraged  to  bear  the  water 
very  hot  (115*  F.)  for  twenty  seconds,  thirty  pounds  pressure,  and 
cold  (60°  to  50°  F.)  for  five  seconds,  if  possible.  This  he  will  be 
able  to  do.  as  there  are  usually  no  cardiac  complications  to  interfere. 
Never  use  cold  immersion  baths  (full  cold  bath,  half  bath,  etc.). 

For  many  years  I  have  alternated  this  procedure  with  the  use  of 
massage,  mechanical  vibration  and  static  electricity,  giving  vigorous 
massage  of  the  muscular  and  joint  structures,  and  applying  heavy 
sparks  to  the  affected  areas,  followed  by  the  use  of  the  static  wave 
current  to  the  affected  joints.  Exercise  in  the  open  air,  especially 
in  the  sunlight,  should  be  enjoined  upon  these  cases.  When  recovered 
they  should  wear  woolen  underwear  all  the  year  round  and  avoid 
strains  upon  joint  and  muscular  structures. 

Muscular  Rheumatism. 

The  so-called  muscular  rheumatism  is,  in  my  opinion,  a  myositis 
which  may  or  may  not  be  set  up  by  the  rheumatic  toxin.  It  is  an 
affection  of  the  voluntary  muscles,  characterized  by  soreness  or  ten- 
derness to  pressure  over  the  affected  muscle,  stiffness  and  discom- 
fort or  pain  on  movement.  My  experience  has  been  that  the  major- 
ity of  cases  are  brought  on  by  exposure  to  cold,  and  occur  in  patients 
who  are  the  subjects  of  gastro-intestinal  intoxications.  I  consider  the 
inflammation  in  its  primary  stage  to  be  of  an  exudative  and  adhesive 
type,  binding  together,  as  it  were,  the  muscular  fibers  or  bundles; 
later  we  have  a  proliferation  of  interstitial  tissue,  which  results  in 
an  infiltration  of  the  muscle  and  subsequent  increase  in  hardness  or 
density.  The  most  frequent  seat  is  that  of  the  lumbar  muscles  {lum- 
bago), the  intercostal  muscles  (pleurodynia),  the  deltoid  and  the 
sterno-mastoid  muscle  (torticollis,  wryneck).  Careful  differential 
diagnosis  should  be  made,  for  many  cases  diagnosed  muscular  rheu- 
matism or  its  subdivision  are  in  reality  neuritis,  an  affection  of  the 
vertebrae  or  some  other  condition  that  may  occur  in  the  locality  af- 
fected. In  the  treatment  of  this  affection  superheated  dry  hot  air 
has  probably  secured  more  rapid  and  brilliant  results  than  any  other 
measure,  and  its  administration  as  described  under  "Chronic  Artic- 
ular Rheumatism"  is  applicable  here.  Where  we  have  a  lumbago  or 
pleurodynia  to  deal  with,  or  even  in  cases  of  wryneck,  we  will  again 
find  that  the  Scottish  douche  is  a  method  that  nearly  always  insures 
prompt  success.  Where  these  methods  are  not  accessible,  however, 
the  electric  light  bath  to  the  affected  part  may  be  employed  for  the 
same  purpose.      If   this   cannot  be  obtained,   the    fomentation   is   the 


294  PRACTICAL  HYDROTHERAPY. 

be:~t   method  to  use.      The  author  has   stopped   the  use  of  liniments 
and  salves. 

I  consider  the  after-treatment  highly  important.  If  the  patient 
would  maintain  health  he  must  keep  his  skin  in  healthy  activity  by 
daily  bathing  and  the  constant  use  of  cold  water.  Where  he  has  access 
to  institutional  treatment,  the  tonic  measures  suggested  in  "Chronic 
Articular  Rheumatism"  apply  here,  as  do  the  applications  of  mas- 
sage and  static  electricity.  Moderate  exercise  in  the  fresh  air  and 
generous  diet,  freedom  from  alcohol,  wines  or  beer,  the  avoidance  of 
tobacco,  free  water-drinking  and  tonic  hydrotherapy  are  the  pre- 
ventive measures  that  will  insure  good  health. 

Rheumatoid  Arthritis. 

Arthritis  deformans  is  a  chronic  progressive  and  destructive  dis- 
ease of  the  joints,  characterized  by  deforming  changes  in  the  synovial 
membranes,  cartilages  and  bones,  with  bony  outgrowths  which  inter- 
fere to  a  greater  or  less  extent  with  the  mobility  of  the  affected  ar- 
ticulations. It  occurs  oftenest  in  women,  and  most  frequently  af- 
fects the  hands,  elbows,  neck  and  knees.  Its  origin  is  not  well  known, 
though  it  is  supposed  to  be  a  trophoneurosis,  and  we  find  it  frequently 
brought  about  by  worry,  grief,  mental  shock,  overwork  and  elements 
that  influence  the  nervous  system.  In  the  majority  of  cases  the 
progress  of  the  disease  is  arrested,  leaving  several  joints  more  or 
less  crippled.  A  few  become  helpless  and  bed-ridden,  but,  as  a  rule, 
the  milder  forms  of  the  disease  are  not  incompatible  with  fair  health 
and  a  long  life.  The  treatment  should  be  commenced  early,  with  the 
object  of  arresting  the  disease  and  preventing  destruction  of  the 
joints.  To  this  end  it  is  of  importance  to  maintain  the  general  health 
at  its  highest  point,  for  it  will  be  found  that  in  proportion  to  general 
good  health  will  the  disease  be  slower  in  progress  and  prompter  in 
arrest.  In  this  disease  the  patient  should  be  well  fed,  with  a  liberal 
dietary  of  meat,  eggs,  milk,  butter,  vegetables,  and  even  malt  liquors 
may  be  advantageously  added.  Fresh  air  and  moderate  exercise  are 
useful  adjuncts. 

The  local  treatment  of  the  affected  joints  embraces  the  use  of 
superheated  dry  hot  air.  local  electric  light  bath,  followed  by  the  appli- 
cation of  the  Scottish  douche  at  115°  F.  for  the  hot  and  70°  F.  for 
the  cold,  thirty  and  five  seconds,  respectively,  three  alternations. 
Where  these  treatments  are  not  accessible  we  may  employ  the  stim- 
ulating compress  at  60°,  wet  in  a  saturated  solution  of  common  or 
sea  salt,  covered  with  a  blanket  or  oil  silk  and  allowed  to  remain 
on  several  hours,  followed  by  movement  of  the  joint  and  local  mas- 
sage. My  own  preference  is  for  superheated  dry  hot  air.  and  it  has 
yielded  me  some  most  excellent  results  where  carefully  and  persist- 
ently applied. 


GOUT.  295 

General  treatment  may  embrace  the  use  of  the  body  apparatus 
for  superheated  dry  hot  air  for  one-half  to  one  hour,  followed  by  the 
rain  bath  at  102°  F.  for  one  and  one-half  minutes,  reduced  to  65° 
F.  for  ten  seconds,  or  the  Scottish  jet  douche  to  the  affected  joints 
and  spine  for  thirty  seconds  at  115°  to  120°  F.,  followed  by  a  tem- 
perature of  60°  F.  for  ten  seconds,  pressure  twenty  to  thirty  pounds. 
In  the  same  manner  we  may  employ  the  incandescent  electric  light 
bath  instead  of  the  superheated  dry  hot  air.  1  have  tried  the  Xau- 
heim  bath  for  this  condition,  but  have  not  found  it  very  serviceable. 
Most  patients  do  best  in  these  conditions  when  sent  to  sanatoria. 
Dry  hot  air  at  a  high  temperature  produces  free  perspiration  and  is 
well  borne.  The  heart  is  unaffected,  the  swelling  and  stiffness  of  the 
joints   combated,   the   pain   relieved. 

As  alternating  treatment  we  may  use  massage,  gymnastics  and  the 
static  wave  current.  Give  the  massage  first  and  follow  this  by  static 
sparks  to  the  spine  and  the  sparks  and  wave  current  to  the  affected 
joints.  I  have  tried  the  cataphoresis  of  mineral  substances  by  the 
galvanic  current  to  the  joints,  but  have  never  seen  the  slightest  ben-( 
efit  result.  Tonics  are  always  useful  in  these  cases,  and  sometimes 
iodide  of  potassium. 

Some  springs  are  valuable  in  this  line — the  hot  springs  of  Arkan- 
sas and  Virginia,  Mount  Clemens  in  Michigan,  Richfield  Springs  of 
New  York,  Bath  in  England,  Baden,  Wiesbaden  and  Carlsbad  in  Ger- 
many. 

Gout. 

Podagra  is  a  constitutional  disease,  usually  the  result  of  an  in- 
herited fault  of  nutrition,  characterized  by  acute  attacks  and  a  chronic 
state,  with  the  presence  of  uric  acid  in  the  blood  and  deposits  of  urate 
of  sodium  in  certain  joint  structures.  My  observation  has  been  that 
fermentation  in  the  intestinal  tract  precedes  the  acute  attacks,  and  is 
present  most  of  the  time  in  the  chronic  form.  This  condition  is 
usually  aggravated  by  free  indulgence  in  eating.  Acute  gout  is  rare 
in  America,  though  the  chronic  form  is  fairly  frequent.  We  prob- 
ably see  more  cases  of  "American"  or  irregular,  commonly  denomi- 
nated lithemia,  in  this  country.  Gout  is  compatible  with  longevity, 
although  it  may  possibly  shorten  life  by  kidney  involvement,  fre- 
quently being  the  origin  of  interstitial  nephritis.  The  essential  ele- 
ments in  the  treatment  and  mangement  of  these  cases,  both  acute 
and  chronic,  may  be  resolved  into  four  distinct  categories:  (1)  Control 
of  dietary;  (2)  counteraction  of  auto-intoxication;  (3)  the  favoring 
of  elimination  and  oxidation  of  proteid  waste  material  and  toxins; 
and  (4)  the  gradual  development  of  vital  resisting  capacity. 

The  diet  should  consist  of  varied  foods.  A  moderate  amount 
of  proteid    food   in   the    form   of   meat   may   be   allowed   once   daily. 


296  PRACTICAL  HYDROTHERAPY. 

Those  meats  that  are  rich  in  nucleins,  such  as  brain,  liver,  kidney, 
thymus,  and  which  increase  uric  acid,  should  be  eliminated  from  the 
diet.  In  this  category  fall  rich  sauces,  pork,  veal,  salted  and  smoked 
meat  or  fish.  One  should  gradually  change  from  a  rich  meat  diet  to 
the  gout  one.  Fats  may  be  generously  used,  and  in  this  line,  milk, 
buttermilk,  butter,  cod-liver  oil,  sevetol  and  Russell's  emulsion  may 
be  employed.  Milk  is  of  advantage,  as  it  increases  the  excretion  of 
xanthin  bases  and  reduces  that  of  uric  acid.  Cereals  of  all  kinds 
may  be  used — oat  meal,  cracked  wheat,  "Force,"  etc.;  fruits,  both 
raw  and  cooked,  with  no  sweetening — raspberries,  blueberries,  straw- 
berries, apples,  oranges,  etc.  Fresh  fish  and  eggs  in  moderation. 
Vegetables  are  excellent.  Peas,  string  beans,  corn,  potatoes,  turnips, 
carrots,  parsnips,  celery,  cauliflower,  artichokes,  salads,  cucumbers, 
egg  plant;  also  bread,  rice,  sago  and  tapioca.  Vegetables  create  hip- 
puric  and  benzoic  acids,  both  of  which  are  solvents  of  uric  acid. 

The  gouty  must  avoid  alcohol,  ales,  beer,  sweet  and  heavy  wines, 
pastry,  pies,  pancakes,  rhubarb,  tomatoes,  radishes,  cabbage,  sugars, 
.sweetmeats,  pickles,  tea,  coffee  and  tobacco.  Water  is  to  be  freely 
drunk  because  of  its  diuretic  effect  and  power  to  remove  the 
alloxuric  bases  (uric  acid,  xanthin)  ;  by  free  use  of  water  I  mean 
the  ingestion  of  at  least  one  gallon  per  diem.  The  alkaline  waters, 
especially  Vichy,  may  be  used  instead  of  the  ordinary  plain  pure 
water,  but  should  be  as  freely  drunk.  The  rule  for  the  gouty  is  to 
eat  slowly,  masticate  thoroughly.  Simplicity  should  be  observed  at 
meals,  thereby  avoiding  a  large  variety  at  one  sitting. 

In  the  treatment  of  the  acute  attack  all  food  should  be  immedi- 
ately shut  off  and  a  brisk  calomel  purge  given,  alkaline  waters  in- 
gested, and  the  wine  of  colchicum  or  some  preparation  containing 
colchicum  administered.  Two  methods  of  local  hydriatic  treatment 
may  be  employed — hot  or  cold.  The  use  of  the  local  superheated  dry 
hot  air  at  a  temperature  of  -100°  F.  for  twenty  minutes  to  one  hour  will 
do  a  great  deal  to  relieve  the  pain  and  swelling  of  the  joint.  The 
local  electric  light  bath  may  likewise  be  utilized  for  imparting  heat 
to  the  affected  part.  If  this  is  not  attainable,  a  very  hot  fomentation 
at  160°  F.,  covered  with  oil  silk,  wrill  be  found  grateful.  Some  cases, 
however,  prefer  the  application  of  the  cold  compress,  repeated  as 
frequently  as  it  may  become  warm.  In  this  we  should  be  largely 
governed  by  the  patient's  feelings,  and  care  must  be  taken  not  to 
overdo  treatment  during  the  acute  attack.  As  soon  ?s  this  subsides, 
institute  the  treatment  below  outlined.  To  counteract  the  auto-intox- 
ication of  the  chronic  state  we  have  recourse  to  the  dietary  above  out- 
lined, to  the  increased  ingestion  of  water  and  the  employment  of 
certain  anti-fermentative  medicines,  the  most  satisfactory  of  which 
have  been,  in  my  hands,  guaiacum,  zinc  or  sodium  Milpho-carbolate 


GOUT.  297 

and  potasssium  permanganate.  The  last  preparation  I  have  made 
with  a  coating  soluble  only  in  the  intestinal  secretion. 

To  encourage  tissue  changes,  elimination  and  the  oxidation  of 
toxins  and  proteid  waste  material,  we  must  have  recourse  to  the 
prolonged  use  of  sweating  measures,  and  to  this  end  we  may  employ 
the  full  dry  pack  for  one  to  one  and  one-half  hours;  the  full  wet 
pack  for  the  same  length  of  time;  the  vapor,  Russian,  Turkish,  electric 
light,  hot  air  bath  or  superheated  dry  hot  air.  After  quite  a  little 
experience  in  the  treatment  of  these  conditions  I  have  gradually 
narrowed  the  treatment  to  the  following:  The  patient  is  placed  in 
the  superheated  dry  hot-air  body  apparatus,  enveloped  in  Turkish 
toweling  and  bath-robe,  and  submitted  to  a  temperature  ranging 
from  250°  to  350°  F.,  and  is  allowed  to  remain  therein  from  twenty 
minutes  to  one  hour,  the  head  being  kept  cool  by  a  cold  compress 
or  an  ice-cap.  This  treatment  may  be  applied  daily,  or  we  may 
alternate  with  this  and  the  local  superheated  dry  hot-air  apparatus 
applied  to  the  joints  affected,  at  a  temperature  from  350°  to  400°  F. 
for  an  hour.  My  experience  in  the  use  of  this  method  has  not  been 
disappointing,  and  I  have  seen  tophi  and  other  solid  manifestations 
of  gout  softened  and  eliminated.  There  is  no  question  but  what  the 
raising  of  the  blood  a  degree  or  two  in  temperature  and  increasing 
the  circulation  in  the  skin  or  in  the  part  affected  produce  changes 
incapable  of  attainment  by  any  medicinal  measure. 

There  is  no  question  of  a  doubt  concerning  the  efficacy  of  the 
stimulating  compress  applied  at  60°  F.  to  the  joints  affected.  The 
compress  should  be  wrung  out  "wet,"  using  a  saturated  watery  solu- 
tion of  common  or  sea  salt,  applied  well  covered  with  flannel,  and 
finally  oil  silk  or  rubber  tissue.  It  must  remain  upon  the  joint  during 
the  night.  I  have  seen  some  good  in  subacute  attacks  from  the 
primary  application  of  heat — a  hot  foot-  or  hand-bath,  fomentation 
or  compress,  followed  by  the  above  method  of  stimulating  compress. 
We  may  in  private  homes  follow  another  method :  Give  a  very  hot 
full  bath  for  five  or  ten  minutes,  taking  care  to  avoid  catching  cold, 
after  which  the  compress  is  applied  to  the  affected  joints.  This 
treatment  is  best  given  in  acute  cases,  night  and  morning;  in  chronic 
cases  at  bedtime. 

The  aim  after  the  above  treatment  should  be  to  gradually  train 
the  patient  to  stand  the  tonic  hydriatic  measures  of  rain  bath  and 
douche,  especially  the  Scottish  douche,  115°  F.  for  the  hot,  60°  F. 
for  the  cold  thirty  and  five  seconds  respectively,  four  alternations. 
It  has  been  my  observation  that  by  so  treating  these  cases  and 
gradually  developing  their  vital  and  resisting  power  through  the  use 
of  tonic  cold  methods  we  not  alone  preserve  the  healch,  but  by  keep- 
ing the   system   free    from   the   causative    factors   prevent   recurrence 


298  PRACTICAL  HYDROTHERAPY. 

of    acute    attacks    and    the    deforming   and    crippling   effects   of    the 
chronic  condition. 

From  time  to  time  gouty  persons  should  suhject  themselves  to 
courses  of  hydrotherapy  as  above  outlined.  This  is  best  obtained 
in  some  institution  or  sanatorium,  where  it  may  be  combined  with 
applications  of  massage  and  static  electricity.  In  my  hands  static 
sparks  to  the  spine  and  over  the  affected  joints,  followed  by  the 
application  of  the  static  wave  current  to  the  affected  parts,  in  con- 
junction with  massage,  hydrotherapy,  diet,  exercise,  gymnastics, 
tonics  and  intestinal  antiseptics,  constitute  the  rational  treatment. 

Where  we  have  to  deal  with  retrocedent  forms,  if  they  be  cerebral, 
cold  should  be  applied  to  the  head  and  the  hot  full  bath  adminis- 
tered; if  gastro-intestinal,  the  hot  abdominal  pack,  the  hot  full  bath 
or  hot  compress. 

Lithemia — Uric  Acid  Diathesis. 

Lithemia,  irregular  or  anemic  gout,  uricemia,  or  the  so-called 
"uric  acid  diathesis,"  is  a  condition  in  which  the  fluids  of  the  body 
are  surcharged  with  nitrogenized  waste  in  the  form  of  uric  acid  and 
other  toxic  bases,  characterized  by  symptoms  of  gastro-intestinal 
indigestion  and  intoxication,  by  indefinite  muscular  and  joint  pains, 
and  by  a  host  of  nervous  symptoms  and  phenomena,  all  of  which 
are  usually  associated  with  a  high-colored,  scanty  urine,  in  which 
crystals  of  urates,  uric  acid  and  oxalates  are  present.  The  writer 
does  not  desire  to  enter  here  into  a  discussion  of  the  relation  between 
these  symptoms  and  "uric  acid,"  but  simply  believes  that  this  is  a 
state  that  has  been  in  the  past  so  denominated,  but  which  in  the 
future  will  probably  be  shown  to  be  due  to  other  toxic  conditions 
than  uric  acid.  Its  origin  is  usually  to  be  traced  to  an  inherent  ten- 
dency on  the  part  of  the  tissue  in  many  cases.  In  others  "high" 
living,  little  physical  exercise,  and  sedentary  habits,  together  with 
the  eating  of  large  quantities  of  proteid  material,  produce  the 
symptoms.  These  cases  have  always  seemed  to  me  to  bear  a  close 
resemblance  to  a  flue  with  an  imperfect  draught,  and  this  is  borne 
out  by  treatment  which  has  for  its  object  increased  and  more  perfect 
oxidation  of  tissue.  The  affection  is  one  in  which  there  is  too  great 
input  and  too  little  output,  for  faulty  elimination  of  waste  products 
is  followed  by  a  most  deleterious  influence,  especially  venting  its 
influence  upon  the  nervous  system.  My  observation  has  been  that  in 
these  cases  the  sphygmomanometer  will  show  a  condition  of  hyper- 
tension in  the  arteries.  The  pulse  is  apt  to  be  hard  and  the  second 
aortic  sound  accentuated.  Failure  to  remove  the  condition  brings 
about  chronic  interstitial  nephritis,  arteriosclerosis  and  heart  disease. 

The  first  indication  for  successful  treatment  is  the  regulation  of 
the  diet.     Proteid  food,  especially  those  rich  in  nucleins  (brain,  liver, 


DIABETES. 

spleen,  thymus,  etc.)  should  be  immediately  cut  out  and  ordinary 
meats  allowed  but  once  daily.  By  gradually  cutting  down  the  quantity 
they  may  be  eliminated  entirely  from  the  bill  of  fare.  Milk,  cream, 
buttermilk,  eggs,  lettuce,  spinach,  celery,  salads,  and  moderate  use 
of  starchy  and  saccharine  foods,  constitute  the  diet.  Fruits  are 
especially  valuable,  and  should  he  eaten  freely,  both  raw  and  cooked. 
The  patient  must  not  be  allowed  to  drink  tea,  coffee,  cocoa,  or  use 
liquors,  wines,  beers  or  tobacco.  In  these  cases  I  have  often  found 
the  use  of  fruit  alone  at  one  meal  valuable  as  an  antiseptic  and 
eliminant.  Exercise,  fresh  air  and  the  free  drinking  of  plain,  alkaline 
and  carbonated  waters  to  the  extent  of  one  gallon  per  diem  must  be 
insisted  upon.  Digestive  disturbances  are  to  be  corrected  according 
to  conditions  found  after  a  test  meal;  constipation  met  by  the  use  of 
the  abdominal  compress  worn  during  the  night  or  the  sinusoidal 
current.  Hydrotherapy  will  do  more  to  cure  these  cases  than  any 
other  method  of  which  I  know.  We  must  increase  the  draught  and 
burn  up  the  waste  material.  For  this  purpose  the  full  hot  bath,  104° 
to  108°  F.,  if  possible;  the  full  wet  pack  at  65°  F.  for  one  hour;  the 
dry  full  pack  for  one  hour ;  the  vapor  bath,  hot-air  bath,  Turkish 
bath,  Russian  bath,  electric  light  or  superheated  dry  hot  air  may  be 
employed.  My  preference  is  for  the  incandescent  electric  light  bath 
administered  until  free  perspiration  takes  place,  followed  by  the  hori- 
zontal rain  bath  at  102°  F.  for  one  to  two  minutes,  reduced  to  70°  F. 
for  one- fourth  minute,  thirty  pounds  pressure,  reducing  the  tempera- 
ture one  degree  daily  to  60°  F.  Later  follow  this  by  the  jet  douche 
to  the  spine  and  legs  at  65°   F.   for  one- fourth  minute. 

Xo  matter  which  method  is  employed,  it  should  be  followed  by 
a  tonic  cold  procedure  of  brief  duration,  commencing  with  a  mild 
application  such  as  the  cold  sponge  rapidly  administered  and  moving 
to  the  dripping  sheet,  rain  bath  and  douche.  The  action  of  this 
method  is  to  increase  the  alkalinity  of  the  blood,  powerfully  stimulate 
oxidation,  favor  elimination  and  destruction  of  toxic  material  in  the 
blood.  This  is  materially  aided  by  the  internal  use  of  water  and  the 
restricted  diet.  Care  must  be  exercised  not  to  overdo  the  treatment 
with  these  patients.  In  sanatoria  we  can  advantageously  combine 
with  the  hydrotherapy,  massage,  both  manual  and  mechanical ;  vibra- 
tion, faradic  and  static  electricity.  I  have  found  medicines  of  little 
practical  curative  value  in  this  trouble.  The  salicylates,  colchicum 
and  alkalies  may  be  tried. 

Diabetes  Mellitus. 

Diabetes  mellitus  is  a  chronic  affection  characterized  by  the  con- 
stant presence  of  grape  sugar  in  the  urine  and  excessive  urinary 
discharge,  with  progressive  loss  of  flesh  and  strength.  Most  com- 
monly observed  in  males,  its  origin  seems  to  rise  from  some  peculiar 


300  PRACTICAL  HYDROTHERAPY. 

disturbance  of  the  nervous  system,  and  possibly  from  the  excessive 
use  of  farinaceous  foods  and  malt  liquors.  The  majority  of  cases 
ultimately  prove  fatal  from  gradual  exhaustion  or  profuse  blood 
poison,  ending  in  diabetic  coma.  Amelioration  of  the  symptoms 
occurs  and  the  progress  of  the  disease  may  be  greatly  retarded,  life 
being  prolonged  for  many  years,  although  complete  lecovery  rarely 
occurs. 

The  treatment  resolves  itself  into  a  regulation  ot  the  diet,  the 
establishment  of  hygienic  laws,  exercise  and  the  use  of  hydrotherapy. 
The  diet  should  contain  a  minimum  quantity  of  starch  and  sugars, 
and  yet  be  as  rich  as  possible  in  fats.  The  absence  of  carbohydrates 
increases  the  tissue  burning,  especially  that  of  the  muscles;  reduces 
the  disagreeable  symptoms,  and,  to  a  certain  extent,  prevents  com- 
plications. The  diet  found  most  satisfactory  must  be  monotonous 
and  consist  of  the  muscular  parts  of  the  ox,  calf,  sheep,  pig,  deer, 
game,  all  to  be  eaten  with  their  gravies ;  also  fish  and  sardines. 
German  sausage,  mackerel,  smoked  ox  tongue,  cream  cheese,  break- 
fast bacon,  butter,  salad  with  mayonnaise  and  cream  furnish  the 
largest  quantity  of  the  food.  Among  the  vegetables,  spinach,  celery, 
lettuce,  cabbage,  tomatoes,  asparagus,  olives,  cucumbers,  sauerkraut, 
■brussels  sprouts,  onions,  water  cresses,  all  kinds  of  nuts,  apples, 
lemons,  strawberries,  etc.,  may  be  used.  Van  Noorden's  and  Crofton's 
diet  tables  will  be  found  of  great  help  in  this  disease. 

Diabetics  may  live  a  long  time  in  comfort  provided  they  will 
submit  to  the  intelligent  control  of  the  physician.  Even  when  they 
are  doing  well  they  should  be  submitted  to  courses  of  treatment  three 
or  four  times  a  year,  during  which  time  they  are  subjected  to  a  close 
restriction  of  diet  and  the  use  of  the  measures  herein  suggested.  As 
long  as  possible  the  occupation  should  be  continued. 

Exercise  is  of  great  advantage  to  the  diabetic.  It  is  best  taken 
in  the  morning,  and  may  consist  of  walking,  hill-climbing,  horseback 
riding,  rowing,  bicycling  or  golfing;  this  latter,  the  writer  believes, 
is  the  most  satisfactory.  Where  the  individual  is  incapable  of  mus- 
cular exercise  much  benefit  can  be  obtained  by  the  use  of  "resistive 
exercise"  administered  immediately  after  the  various  hydrotherapeu- 
tic  methods  to  be  hereinafter  indicated.  The  author  has  found  it  very 
satisfactory  to  combine  the  use  of  massage  and  mechanical  vibration 
with  exercise,  but  this  must  not  be  used  as  a  substitute  for  exercises 
in  the  open  air,  as  it  has  a  tendency  to  destroy  the  patient's  self-reliance 
and  activity,  a  condition  that  is  present  and  which  must  be  combated. 

Hydrotherapy  is  one  of  the  most  satisfactory  of  measures  that 
can  be  employed  in  these  diseases,  but  as  diabetics  do  not  always 
stand  hydrotherapy  well,  at  the  start  they  must  be  carefully  studied 
and  trained  to  treatment.  Cold  tonic  hydriatic  measures  are  the  aim, 
the  best  results  being  obtained  when  the   full  effect  of  the  douches 


DIABETES.  301 

arc   readied.      The  basis  of  all   successes   in   the   use   of   water  with 
diabetics  is  the  question  of  reaction,  which  must  be  carefully  watched. 
I   may   say.   in   passing,  that  chemical   and   medicinal   baths    found   at 
springs  or  medicated  at  home  possess  no  value  over  the  plain  and 
simple    bath.      Baths    containing    peat,    mud    and    other    similar    sub- 
stance., arc  absolutely  detrimental  to  the  diabetic,  and  tend  to  produce 
irritation   and   inflammation  of  the  skin,   one  of  the  dangers  of  the 
disease.     The   influence  of   the   treatment   when   fully  established   is 
that  of  a  tonic  roborant,  with  an  increase  of  the  circulation  and  good 
feeling   of    the   patient.      This   psychic   effect,   brought   about   by   the 
thousands  of  sensory  impressions  travelling  through  the  skin  to  the 
brain,   is   of   great   value   in    increasing   "the   fighting  power"   of   the 
patient,  and  should  not  be   forgotten.     We  can  commence  the  treat- 
ment by   the  use  of  the  hot  pack  until  the   skin  is  warm  and  the 
cutaneous  blood-vessels  dilated.     This  should  be  followed  by  a  rapid 
cold  sponge  at  a  temperature  of  60°   F.       As  soon  as  the  patient 
responds  substitute  for  the  cold  sponge  the  wet  sheet  rub  at  75°  F., 
lowering  the  temperature  two  degrees  until  60°  F.  is  reached.     Now 
institute  the   electric  light   bath,   hot  air  or   superheated   dry  hot  air 
to   the   point   of   perspiration,   then   apply   the   circular   rain   bath   at 
104°  F.  for  two  minutes,  reduced  to  90°  F.  for  half  minute;  lower 
the  temperature  of  the  cold  water  until  60°  F.  is  reached,  increasing 
the  pressure.     By  this  time  reaction  will  have  been  well  established 
and  we  may  proceed  with  the  full  treatment.     The  author  prefers  the 
electric  light  bath  continued  until  the   patient  perspires;  he   is  then 
removed  to  the  rain  bath  at  104°  F.  for  two  minutes,  reduced  to  90° 
F.  for  fifteen  seconds;  this  is  followed  by  the  jet  douche  to  the  spine 
and  lower  limbs  and  fan  douche  to  the  body  at  a  temperature  of  80° 
F.    for   one-half   to   one   minute.      These   temperatures   should   all   be 
gradually  reduced  one  or  two  degrees  daily  until  60°  F.  or  even  50°  F. 
is  reached.     The  pressure  should  range  between  fifteen  pounds  at  the 
start  to  thirty  at  the  termination. 

Crofton1  called  attention  to  the  fact  that  the  glycolytic  or  sugar- 
destroying  ferment  was  increased  by  cold  water  applications,  due 
doubtless  to  the  increased  leucocytosis  that  follows  the  bath,  as  these 
cellular  bodies  are  carriers  of  the  ferment;  in  this  way  the  sugar  is 
more  rapidly  destroyed,  sometimes  as  much  as  50  per  cent,  in  a  few 
days.  In  addition,  as  we  have  heretofore  shown  in  the  earlier  pages 
of  this  work,  the  alkalinity  of  the  blood  is  increased  as  well  as  its 
oxidative  power,  hence  a  diminution  of  the  usual  acidosis  and  a  de- 
struction of  toxins  usually  present.  There  is  no  question  but  what 
this  treatment  is  followed  by  an  increased  absorption  of  oxygen, 
better  elimination  of  carbon  dioxide,  and  as  a  result  an  increased  ox- 
idation of  sugar,   due  to  better  activity  of  the  muscular  structures 

1   Croftan,   A.    C. :    Medicine.   January,    1904. 


302  PRACTICAL  HYDROTHERAPY. 

through  the  use  of  the  douche.  The  author,  as  above  stated,  in  many 
cases  prefers  the  use  of  resistive  exercise  immediately  after  the  bath. 
Among  the  most  distressing  of  all  the  symptoms  from  which  the 
diabetic  suffers  is  pruritus.  The  itching  at  times  drives  the  patient 
to  scratching  the  skin,  as  a  result  of  which  we  often  find  infection, 
boils,  acne,  etc.  It  interferes  with  sleep  and  leaves  the  sufferer  weak 
and  exhausted.  Nothing  in  my  hands  has  given  such  satisfaction  as 
the  neutral  bath  applied  at  bedtime  for  one-half  to  one  hour,  relieving 
the  itch  and  inducing  sleep.  The  genitalia  should  be  bathed  carefully 
twice  daily  and  dressed  with  zinc  stearate.  Some  authors  have  found 
the  carbon  dioxide  bath  of  benefit,  but  this  has  not  been  the  writer's 
experience.  During  the  interims  of  treatment  swimming  will  be 
found  an  excellent  measure,  as  it  combines  the  thermic  effect  of  the 
water  with  exercise,  especially  one  that  increases  respiratory  action. 

Diabetes  Insipidus. 

Polyuria  is  an  affection  characterized  by  the  continued  excessive 
secretion  of  a  very  large  quantity  of  pale,  watery  urine,  free  from 
albumin  and  sugar.  It  has  its  origin  most  frequently  in  diseases  of 
the  nervous  system,  especially  hysteria,  injuries,  tumors,  etc.,  although 
malaria  and  syphilis  may  produce  the  condition.  It  seems  to  o  i 
of  a  dilatation  of  the  renal  vessels,  the  result  of  improper  innerva- 
tion. The  quantity  of  urine  passed  is  sometimes  enormous,  ranging 
from  one  to  five  gallons  in  the  twenty-four  hours.  The  author  has 
seen  two  and  one-half  gallons  passed  in  a  case  of  fracture  of  the 
skull,  which  recovered.  While  the  prognosis  is  rather  unfavorable 
to  a  radical  cure,  the  patient  may  be  kept  in  excellent  condition  by 
avoiding  intercurrent  maladies.  The  best  treatment  for  the  trouble 
has  been  found  to  be  a  regulation  of  the  diet,  plenty  of  fresh  air,  the 
wearing  of  flannels  and  the  application  of  the  various  measures  su  :- 
gested  under  the  head  of  diabetes  mellitus.  This  exception  should, 
however,  be  made,  that  the  temperature  should  not  be  given  lower 
than  60°  F.  I  have  seen  good  come  from  this  character  of  treatment 
alone.     Hydrotherapy  is  aided  by  the  use  of  the  bromides  and  ergot. 

Obesity. 

Adiposita's  is  a  disease  of  nutrition,  characterized  by  the  deposi- 
tion of  an  excessive  amount  of  fat  in  many  parts  of  the  body.  The 
amount  of  fat  in  a  healthy  adult  is  about  one-twentieth  of  the  body 
weight,  and  the  possession  of  a  considerable  amount  of  this  tissue  is 
a  valuable  asset  in  health.  It  represents  a  reserve  capital  to  be  drawn 
on  in  time  of  need,  thus  diminishing  drain  on  tissue  proteids.  In 
many  cases  there  is  an  hereditary  tendency,  this  tendency  prob.ibly 
being  an  abnormally  low  power  of  fatty  oxidation.  It  is  more  fre- 
quent in  women,  is  found  in  those  who  over-eat  and  over-drink,  and 


OBESITY.  303 

is  usually  accompanied  by  anemia.  This  anomaly  is  probably  ex- 
plained by  the  diminished  oxidizing  power  of  the  blood  brought  about 
by  the  loss  of  hemoglobin,  which  is  the  oxygen-carrier.  Treatment 
has  for  its  aim  to  check  the  formation  of  fat  and  rid  the  body  of  its 
accumulations.  Cases  may  be  roughly  divided  into  two  classes,  those 
that  exhibit  no  heart  symptoms  and  those  that  have  heart  symptoms. 
The  diet  must  be  regulated,  must  be  monotonous,  the  consumption  of 
fluids  fairly  limited,  alcohol,  wines  and  beers  forbidden.  Cold  water 
charged  with  carbonic  acid  gas,  or  plain  water  in  which  Vichy  or 
Kissengen  salts  have  been  dissolved,  may  be  given  in  limited  amounts. 
The  daily  program  of  treatment  that  has  been  found  satisfactory 
is  that  of  V.  Hoesslin8:  6:30  a.m.,  cold  sponge,  walking  or  other  ex- 
ercise for  half  or  three-quarters  of  an  hour ;  7 :30,  breakfast,  tea  or 
coffee  with  cream,  one  slice  brown  bread,  thickly  spread  with  butter; 
9 :30.  one  egg  or  slice  of  fat  bacon  ;  10  to  12  :30,  exercise  ;  12  :30,  lunch, 
bouillon  and  egg,  fat  meat  with  salad,  an  apple,  brown  bread  and 
mineral  water;  1:30  p.m.,  rest  and  then  a  cup  of  tea  or  coffee;  3:15 
to  6:15.  oercise;  7:00,  dinner  of  proteid  food  and  green  vegetables 
chiefly.  Billiards  or  skittles  may  fill  up  the  evening.  The  various 
dietaries  suggested  by  Oertel,  Ebstein  and  Anders3  may  be  used  to 
vary  the  plan  of  V.  Hoesslin.  Sleep  during  the  daytime  should  be 
absolutely  forbidden,  the  patient  to  go  to  bed  at  11  p.m.  and  rise  at 
6  a.m.  during  the  summer  and  7  a.m.  during  the  winter,  not  more 
than  six  or  seven  hours  of  sleep  for  the  adult  and  eight  hours  for  the 
child.  Exercise  is  of  great  value,  and  its  use  in  the  open  air  must 
be  insisted  on.  This  may  consist  of  walking  for  half  or  three-quarters 
of  an  hour  after  each  meal — that  is  to  say,  four  or  five  times  a  day. 
The  time  spent  in  exercise  should  be  short  at  first  and  gradually  in- 
creased, likewise  the  gait  changed  from  a  quiet  to  a  brisk  movement. 
In  this  respect  women  are  refractory  patients.  Gymnastics  and  out- 
of-door  sports,  if  wisely  regulated  so  that  overstrain  is  not  produced, 
will  break  the  monotony  of  the  treatment.  Oertel  believes  in  gradu- 
ated exercise  up  slight  elevations  and  inclines,  beginning  with  slight 
efforts  and  gradually  increasing  them.  He  has  laid  out  at  his  sana- 
torium special  walks  with  this  in  view,  it  playing  an  important  part 
in  his  system  of  treatment.  He  believes  that  it  directly  and  methodi- 
cally invigorates  the  heart  muscle.  In  severe  cases  the  exercise  some- 
times cannot  be  taken.  In  these  vigorous  massage,  or,  what  is  better, 
mechanical  massage  and  vibration,  may  be  substituted  until  the  pa- 
tient is  able  to  exercise.  Sir  Andrew  Clark  and  others  have  suggested 
the  use  of  the  stair  in  the  treatment  of  obesity.  The  patient  should 
start   from  the  top  of  a  tall  building  and  descend  the  steps.     Later 

2  V.    Hoesslin:    Edinbu-gh    Medical    Journal,    1899. 

3  Oertel,    Etstein,    Anders,    T.    M.:    "Sajous'   Analytical   Cyclopedia  of  Practical   Medicine," 
Vol.   Ill,   p.    114,   1905. 


304  PRACTICAL  HYDROTHERAPY. 

ascensions  are  made.  Muscular  activity  must  be  extended  over  three 
or  four  hours  daily.  The  reason  for  this  is  the  muscles  are  better 
nourished  and  absorb  more  food  supply  in  direct  proportion  to  the 
length  of  time  muscular  action  is  continued. 

Hydrotherapy  is  of  value  in  obesity,  and  should  have  for  its  aim 
moderately  prolonged  cold  baths ;  it  is  valuable  per  se  and  as  an  aid 
to  all  other  measures.  We  may  start  with  the  wet  sheet  pack  at  65° 
F.,  continued  for  one  hour,  followed  by  the  half  bath  at  60°  F.  for 
three  minutes.  The  writer  prefers  the  use  of  the  electric  light  bath, 
hot  air  or  vapor  bath,  or  superheated  dry  hot  air,  used  until  profuse 
perspiration  takes  place,  followed  by  some  cold  tonic  procedure.  The 
preference  should  be  given  to  the  electric  light  bath  continued  for 
fifteen,  twenty  or  even  thirty  minutes,  or  superheated  dry  hot  air, 
general  application  for  one  hour,  producing  profuse  perspiration, 
followed  by  a  soap  shampoo  and  half  bath,  temperature  70°  F.,  for 
three  minutes,  followed  by  the  jet  douche  at  65°  F.  to  the  spine  and 
all  over  each  extremity,  and  a  strong  fan  douche  to  the  abdomen  and 
chest,  total  duration  one  minute,  temperature  of  the  water  to  be  grad- 
ually lowered  to  50°  F.  and  the  force  of  the  douche  increased.  These 
baths  will  be  found  invigorating,  stimulating  and  oxidizing.  The  pa- 
tient should  dress  quickly  and  exercise  for  an  hour  in  the  fresh  air. 

Swimming,  where  prolonged  for  one  or  two  hours  daily,  combines 
two  factors  capable  of  fat  destruction,  viz.,  cold  and  exercise.  Swim- 
ming is  not,  as  a  rule,  hard  upon  fat  people,  whose  bulk  enables  them 
to  float  easily  in  the  water.  Where  this  desideratum  cannot  be  at- 
tained, the  full  bath  at  102°  F.,  in  which  the  patient  sits  and  makes 
movements,  may  be  substituted,  although  it  is  nothing  like  as  good. 
The  water  should  be  gradually  reduced  to  75°  or  70°  F.  and  the  dura- 
tion range  from  fifteen  to  thirty  minutes.  If  the  patient  begins  to 
shiver  and  the  hands  and  feet  to  get  cold,  the  bath  must  be  stopped. 
It  is  an  excellent  plan  to  finish  the  treatment  with  the  shower  or  jet 
douche  at  60°  F.  for  fifteen  to  twenty  seconds,  applied  to  the  spine, 
back,  legs  and  arms. 

Hot  applications  for  the  reduction  of  flesh  should  never  be  too 
greatly  prolonged,  and  are  finished  by  a  vigorous  cold  application. 
A  short  general  cold  application  following  an  application  of  heat  for 
the  purpose  of  producing  perspiration  to  reduce  weight  in  obesity, 
has  the  effect  of  restoring  and  increasing  the  disposition  for  muscular 
effort,  in  addition  to  the  tonic  effect  upon  the  general  nervous  sys- 
tem. This  enables  the  patient  to  add  to  the  spoliative  effects  of  the 
hot  bath  the  still  more  positive  effects  of  prolonged  muscular  ex- 
ercise. 

In  those  cases  in  which  the  subjective  signs  of  heart  involvement, 
dyspnea  and  palpitation,  are  present,  the  graduated  climbing  or  walk- 
ing of  Oertel  is  of  great  benefit  in  conjunction  with  the  use  of  the 


RACHITIS.  305 

Xauhcim  or  Schott  method  of  treating  heart  disease.  These  baths 
should  be  commenced  at  a  temperature  of  94°  F.  for  five  minutes 
and  gradually  increased  in  acid  and  alkali,  in  time  and  temperature, 
until  76°  F.  is  reached,  with  twenty  minutes'  duration. 

In    conjunction    with   the   above   treatment   arsenic,   strychnia   and 
thyroid  extract  may  be  used. 

Rachitis. 

Rickets  is  a  nutritional  disease,  occurring  in  early  childhood,  char- 
acterized by  changes  in  the  structure  of  the  bones,  with  consequent 
deformity,  muscular  weakness  and  nervous  symptoms.  Its  causation 
is  unknown,  but  syphilis,  foul  air,  unhygienic  surroundings,  damp- 
ness, poverty,  all  predispose.  The  negro  is  especially  subject  to  the 
disease.  In  rickets  all  the  tissues  are  diseased,  though  the  bony  tis- 
sues are  particularly  affected.  The  aim  of  treatment  should  be  to 
at  once  get  the  child  out  of  its  surroundings  and  change  its  diet; 
sunlight  and  fresh  air,  if  possible,  at  the  seashore  or  in  the  country. 
Denizens  of  the  city  and  those  too  poor  to  send  children  away  must 
keep  them  out  in  the  air,  upon  the  roofs,  in  the  parks,  or  make  daily 
excursions  to  suburban  parts.  The  diet  should  be  at  once  changed, 
and  the  nursling  fed  by  means  of  pasteurized  milk;  older  children 
must  be  given  much  fats,  butter,  milk,  cream,  purees  of  vegetables, 
eggs,  lentils,  beans,  brains,  sweetbreads,  oranges,  lemons,  grapes,  etc. 
Phosphate  of  lime,  syrup  iodide  of  iron,  lime  water,  etc.,  are  indi- 
cated. 

Hydrotherapy  is  very  useful.  The  best  method  is  the  daily  use 
of  the  full  warm  bath  at  98°  to  100°  F.  for  ten  to  twenty  minutes, 
followed  by  a  brief,  brisk  cold  sponge.  Commence  the  treatment  by 
giving  each  morning  fin  a  room  of  proper  temperature)  the  full 
warm  bath,  the  first  day  ten  minutes,  increasing  each  day  two  minutes 
until  twenty  minutes  is  reached.  As  soon  as  the  bath  is  finished,  rap- 
idly sponge  the  child.  The  first  day  the  water  should  be  90°  F.,  and 
each  day  the  temperature  is  lowered  one  or  two  degrees  until  70° 
F.  is  reached.  The  sponging  must  be  general  and  very  quickly  per- 
formed. Manual  massage  is  of  unquestioned  value,  and  used  in  con- 
nection with  cocoanut  oil  will  aid  in  increasing  weight.  Galvanism 
or  the  galvano-faradic  current  from  nape  to  epigastrium,  or  the  spinal 
form,  one  pole  at  the  nape,  the  other  upon  the  sacrum,  may  be  em- 
ployed. Institutional  methods  embracing  these  three  treatments  daily 
make  prompt  showing  in  rachitic  cases. 


CHAPTER  XV. 
DISEASES  OF  THE  KIDNEY  AND  BLOOD. 

Renal  Hyperemia. 

Congestion  of  the  kidney  consists  of  an  increase  in  the  amount 
of  blood  in  the  vessels  of  this  organ,  characterized  by  pain,  frequent 
micturition,  scanty,  high-colored  urine,  containing  albumin  and  some- 
times blood.  It  most  frequently  originates  from  cold  and  exposure, 
though  it  sometimes  occurs  where  irritating  substances  are  eliminated 
through  the  kidneys.  Mechanical  causes  produce  a  passive  hyper- 
emia, usually  from  obstructive  conditions,  originating  in  the  heart, 
lung  or  liver.  An  endeavor  should  be  made  to  treat  the  disease  as 
soon  as  possible,  and  upon  ascertaining  the  cause  this  must  be  re- 
moved and  the  patient  at  once  put  to  bed  upon  a  liquid  diet,  or,  what 
is  better,  milk  in  very  moderate  quantities.  A  dose  of  calomel,  fol- 
lowed by  a  saline,  and  bland  alkaline  drinks,  should  be  administered. 
The  author  does  not  believe  in  copious  water-drinking  with  the  idea 
of  promoting  diuresis,  believing  that  this  can  be  best  accomplished  by 
the  ice-bag  or  cold  compress  applied  to  the  lower  third  of  the  sternum. 
Those  methods  that  produce  free  and  active  perspiration,  and  by  their 
action  drive  the  blood  to  the  surface  of  the  body,  should  be  at  once 
employed  to  assist  in  relieving  the  internal  visceral  congestion.  The 
writer's  preference  is  decidedly  for  the  use  of  the  body  apparatus, 
superheated  dry  hot  air,  and  he  believes  that  in  these  conditions  of 
the  kidney  this  produces  quicker  diaphoresis  than  almost  any  other 
form  of  treatment.  The  method  that  has  given  him  the  greatest  sat- 
isfaction is  the  following:  Superheated  dry  hot  air  for  twenty,  thirty 
or  sixty  minutes,  according  to  the  case,  at  temperatures  ranging  from 
200°  to  300°  F.,  followed  by  the  dry  blanket  pack  for  twenty  min- 
utes, during  which  time  fomentations  are  applied  over  the  kidneys. 
Where  this  method  is  not  accessible  we  may  employ  the  hot  full  bath 
for  one-half  hour,  after  which  the  patient  should  have  light  friction 
to  further  favor  cutaneous  congestion  and  elimination,  followed  by 
the  fomentation  over  the  kidney.  In  the  same  way  as  the  superheated 
dry  hot  air  we  may  employ  the  ordinary  hot  air  bath,  electric  light 
bath  and  steam  baths.  In  this  condition  the  Turkish  bath  has  proven 
of  great  benefit,  acting  in  the  same  general  way  that  other  measures 
do  that  produce  an  increased  skin  circulation.  Winternitz  suggests 
the  use  of  the  cold  sitz  baths  at  50°  to  70°  F.  for  two  to  five  minutes, 
but  the  writer  has  never  found  them  of  much  value.  Prompt  measures 
(306) 


DISEASES  OF  THE  KIDNEY  AND  BLOOD.  307 

of  the  character  indicated  will  oftentimes  prevent  a  renal  hyperemia 
becoming  an  acute  nephritis,  of  which  it  may  oftentimes  be  consid- 
ered to  be  the  primary  stage.  Convalescence  should  be  marked  by 
a  careful  return  to  the  diet  suggested  for  chronic  Bright's  disease  and 
the  use  of  the  different  measures  that  are  suggested  under  that 
heading. 

Acute  Nephritis. 

Acute  parenchymatous  nephritis,  or  acute  Bright's  disease,  is  an 
acute  inflammation  of  the  epithelium  of  the  uriniferous  tubules,  char- 
acterized \>y  fever,  scanty,  high-colored  urine,  dropsy,  acute  uremia 
and  more  or  less  nervous  symptoms.  It  occurs  most  frequently  from 
exposure  to  cold,  especially  wet  cold,  though  irritant  drugs  occasion- 
ally produce  the  disease.  It  is  common  in  children  following  acute 
infectious  diseases,  especially  the  exanthemata.  In  the  management 
of  acute  nephritis  time  is  an  essential  factor,  and  the  physician  must 
move  quickly  in  establishing  those  measures  that  will  take  the  load 
off  the  kidney  and  prevent  destructive  changes.  The  patient  should 
be  placed  absolutely  at  rest  in  a  warm  bed,  be  clothed  in  woolen 
underwear,  and  the  room  itself  kept  sufficiently  warm  to  favor  per- 
spiration. The  diet  must  be  liquid,  and  where  the  patient  is  able  to 
withstand  entire  removal  of  food  nothing  should  be  given  but  plain 
water  and  hot  lemonade.  The  author  is  not  in  favor  of  the  drinking 
of  large  quantities  of  water  in  this  disease,  as  harm  is  frequently 
done  by  so  doing.  He  believes  that  very  moderate  use  of  water, 
preferably  hot,  sipped  with  a  teaspoon,  will  go  quite  a  long  distance 
toward  allaying  thirst  and  overcoming  nausea  should  it  exist.  The 
bowels  should  be  moved  by  means  of  calomel  and  a  saline,  and  kept 
active  by  the  administration  of  a  high  hot  saline  enema  at  least 
twice  daily.  While  it  is  our  endeavor  to  produce  prompt  perspira- 
tion and  maintain  same,  excessive  diuresis  should  not  be  aimed  at. 
Where  the  secretion  is  very  scanty  we  may  increase  it  by  the  use  of 
the  very  hot  fomentation  over  the  kidney  at  140°  to  160°  F.  for 
twenty  minutes  every  three  hours,  and  by  the  application  of  the  ice- 
bag  over  the  lower  third  of  the  sternum.  The  writer  believes  that 
hydrotherapy  is  the  most  certain  and  valuable  therapeutic  weapon 
for  the  management  of  this  disease.  There  is  an  intimate  reciprocal 
action  between  the  skin  and  kidney,  for  while  diaphoresis  stimulates 
this  compensatory  action  of  the  skin  it  must  not  be  forgotten  that 
it  is  not  done  for  its  eliminant  action  alone.  Even  under  free 
action  of  the  skin  only  a  moderate  degree  of  elimination  takes  place 
as  compared  with  the  kidney,  but  its  influence  is  certainly  beneficial 
and  stimulates  other  organs  that  would  otherwise  refuse  to  act. 
Any  number  of  methods  are  open  to  the  practitioner.  Where  access 
cannot    be    had    to    hospital    or    sanatorial    treatment,    we    may    em- 


308  PRACTICAL  HYDROTHERAPY. 

ploy  the  hot  full  bath  at  100°  to  110°  F.  for  twenty  to  forty  minutes. 
This  is  especially  a  valuable  procedure  with  children  when  followed 
by  the  full  dry  pack  for  twenty  to  forty  minutes.  To  both  of  these 
methods  may  be  added  gentle  superficial  friction  in  order  to  maintain 
active  circulation  in  the  skin.  There  is  no  fixed  rule  to  guide  one  in 
the  administration  of  these  measures ;  some  cases  do  well,  some  do 
not :  it  is  largely  a  matter  of  careful  trying.  In  sanatoria  the  hot  air 
bath,  electric  light  bath  or  superheated  dry  hot  air  are  valuable.  The 
author  much  prefers  the  latter,  administering  the  general  application 
in  the  body  apparatus  for  twenty  to  sixty  minutes  at  200°  to  300° 
F.,  followed  by  the  hot  blanket  pack  for  thirty  minutes,  with  the 
simultaneous  use  of  the  fomentation  to  the  kidney.  The  action  of 
these  methods  is  to  divert  half  or  two-thirds  of  the  blood  in  the  body 
to  the  skin,  acting  in  this  respect  like  a  great  suction  pump,  relieving 
the  internal  congestion,  together  with  the  interference  of  function 
that  results  therefrom.  There  is  danger  from  chilling,  and  too  great 
care  cannot  be  exercised  in  this  regard,  as  chilling  of  the  surface 
will  undo  all  the  benefit  derived  from  the  heating  measures.  Should 
cardiac  weakness  develop,  the  ice-bag  over  the  heart  for  fifteen  minutes 
every  two  hours  may  be  employed.  Cerebral  symptoms  are  best  met 
by  the  cold  cephalic  compress  or  coil-cap  to  the  head. 

Chronic  Nephritis;   Chronic  Parenchymatous   and   Chronic 
Interstitial  Nephritis. 

Chronic  parenchymatous  nephritis  is  a  chronic  inflammation  of  the 
cortical  tubular  structure  of  the  kidney,  characterized  by  albuminous 
urine,  dropsy  and  attacks  of  acute  uremia.  Chronic  interstitial  ne- 
phritis is  a  chronic  inflammation  of  the  interstitial  connective  tissue 
of  the  kidney,  slow  in  progress,  characterized  by  the  passage  of  large 
quantities  of  pale  urine  of  low  specific  gravity,  albuminous;  disorders 
of  the  gastro-intestinal  and  nervous  systems.  It  is  nearly  always  ac- 
companied by  cardiac  hypertrophy.  Chronic  nephritic  changes  are 
usually  in  their  incipiency  cardio-vascular.  before  the  true  kidney 
conditions  commence  to  be  present.  These  cardio-vascular  conditions 
are  accompanied  by  high  blood-pressure,  hypertension,  a?  a  result  of 
which  disturbances  occur  in  those  organs  that  are  supplied  by  end- 
arteries,  -chief  among  which  are  the  kidney,  retina  and  brain.  The 
most  frequent  influences  that  are  said  to  produce  the  disease  are  ex- 
posure to  cold,  alcohol,  hepatic  disease,  and  certain  nervous  influences, 
especially  worry,  grief  and  anxiety.  The  writer  is  inclined  to  believe 
that  the  origin  of  chronic  nephritis  is  most  frequently  to  be  found 
in  those  who  are  given  to  the  habit  of  constantly  over-eating,  as  a 
result  of  which  their  systems  are  continually  saturated  with  toxins 
circulating  in  the  blood.  In  such  cases  we  find  the  metabolism  of  the 
body  lessened  and  elimination  by  every  channel  diminished.     With  the 


DISEASES  OF  THE  KIDNEY  AND  BLOOD.  309 

digestive  disturbance  comes  an  hepatic  torpor  or  inability  to  cope 
with  the  Hood  of  poisons  circulating  through  the  liver;  the  liver  cells 
become  incapable  of  eliminating  or  destroying  these  toxins.  The 
final  result  of  all  this  is  a  state  of  malnutrition  upon  which  is  super- 
imposed nephritic  and  other  constitutional  conditions.  The  progno- 
sis as  to  a  structural  cure  is,  of  course,  unfavorable,  but  excellent  re- 
sults may  be  obtained  and  life  preserved  for  many  years  by  the  insti- 
tution of  proper  treatment.  It  seems  to  the  author  that  much  of  the 
gloomy  prognosis  would  be  abated  provided  the  patients  could  always 
have  access  to  an  intelligent  management  of  their  cases,  and  were 
willing  to  patiently  follow  out  the  treatment.  As  ordinarily  treated, 
it  is  a  grave  and  serious  disease ;  under  favorable  treatment  these  pa- 
tients live  many  years  of  great  comfort  and  usefulness. 

A  quiet  life,  free  from  anxiety,  worry  and  care,  is  to  be  sought, 
and,  if  possible,  found — certainly  a  difficult  matter.  The  out-of-door 
life  in  an  equable  and  uniform  climate  is  very  desirable.  How  few 
can  seek  the  magic  and  health-giving  climates  of  Egypt,  the  Riviera, 
Pasadena,  Cal.,  or  Palm  Beach!  The  diet  should  be  varied  and  liberal. 
It  should  be  mixed,  and  our  endeavor  should  be  to  feed  the  patient 
rather  than  run  the  risk  of  letting  him  become  anemic.  Carefully 
watch  the  digestive  disorders,  which  can  frequently  be  regulated  by 
lavage  and  hydrotherapeutic  treatment.  We  may  allow  a  general 
mixed  diet,  from  which  tea,  coffee,  cocoa,  alcohol,  cabbage,  rhubarb, 
cheese,  lobster,  fried  and  greasy  foods  have  been  removed.  Meat 
should  never  be  eaten  in  excess,  and  at  best  in  moderation  twice  daily. 
Saundby  truly  remarks :  "Eat  sparingly  of  butcher's  meat,  avoid  malt 
liquors,  spirits  and  strong  wines."  In  the  author's  opinion,  Crofton1 
is  unquestionably  correct  in  restricting  the  quantity  of  water  to  be 
drunk.  From  a  no  small  experience  I  can  confirm  absolutely  his 
observations  along  this  line.  Of  the  limited  amount  of  water  allowed 
we  may  permit  the  patient  to  use  the  ordinary  diluent  table  waters. 
The  clothing  should  be  warm  and  arranged  to  meet  the  seasons  so 
as  to  prevent  chilling.  Constipation  must  be  systematically  treated, 
and  a  regular  movement  from  the  bowels  secured.  Excesses  of  all 
kinds  must  be  scrupulously  avoided,  especially  sexual.  Hydrotherapy 
is  of  great  value,  its  aim  and  action  being  to  relieve  the  diseased  or- 
gan and  place  it  at  rest  as  nearly  as  possible,  and  by  securing  this 
functional  rest  we  maintain  the  renal  parenchyma  in  good  condition. 
Moderate  sweating  and  active  skin  action,  favoring  elimination  and 
improving  the  nervous  system,  should  be  our  aim ;  too  energetic  sweat- 
ing is  bad.  In  the  parenchymatous  variety  sweating  measures  have 
in  the  author's  hands  given  so  much  satisfaction  that  in  his  practice 
he  has  practically  limited  his  treatment  to  their  use  as  a  hydrothera- 
peutic measure.     Commence    with  the  wet  full  pack  at  90°  for  twenty 

1  Crofton,   A.   C. :     "Clinical   Therapeutics,"    1906. 


310  PRACTICAL  HYDROTHERAPY. 

minutes.  Increase  the  duration  five  minutes  and  decrease  the  tem- 
perature three  degrees  daily  until  70°  F.  is  reached.  The  duration  at 
no  time  should  exceed  one  hour.  If  the  heart  is  accelerated  and  res- 
piratory action  quick,  we  may  apply  an  ice-bag  to  the  heart  over  the 
pack.  The  action  of  the  treatment  is  to  lower  blood  pressure,  besides 
influencing  the  patient  in  the  manner  outlined  under  the  section  in 
which  this  measure  is  treated.  The  other  measure  is  superheated  dry 
hot  air,  using  the  body  apparatus  at  a  temperature  of  200°  to  300° 
F.  for  twenty,  forty  or  sixty  minutes,  keeping  the  head  cool  by  means 
of  an  ice-bag,  and  in  this  case,  as  in  the  pack,  applying  the  ice-bag  to 
the  heart  if  its  action  is  much  accelerated.  Either  of  these  measures 
should  be  followed  by  the  horizontal  or  circular  rain  bath  at  70°  F. 
for  one-fourth  minute.  Note  should  be  taken  that  in  this  treatment 
no  hot  water  is  administered  in  the  rain  bath. 

In  the  cirrhotic  form  we  may  employ  superheated  dry  hot  air  at 
200°  to  300°  F.  for  twenty  to  thirty  minutes,  or  the  electric  light 
bath  for  five  to  ten  minutes,  followed  by  the  dripping  sheet  at  70° 
for  three  minutes,  accompanied  by  vigorous  friction.  As  soon  as 
the  patient  reacts  well  we  may  substitute  for  the  dripping  sheet 
the  circular  rain  bath  at  104°  F.  for  one  minute,  reduced  to  70° 
F.  for  one-half  minute,  twenty  pounds  pressure,  increasing  pressure 
one  pound  daily  until  thirty  is  reached.  Xote  that  the  temperature  is 
not  reduced  below  70°  F.  If  the  heart  is  perturbed  the  treatment  may 
be  followed  by  the  use  of  the  ice-bag  to  the  precordium  from  fifteen 
minutes.  Under  this  treatment  it  will  be  noticed  that  arterial  tension 
is  lessened,  digestive  disorders  improved,  bronchitis  removed  and  the 
nervous  system  markedly  toned. 

The  Turkish  bath  is  very  frequently  prescribed  in  these  conditions, 
but  it  must  be  most  carefully  used  and  prescribed  under  the  physi- 
cian's order.  This  bath  is  usually  left  to  the  unintelligent  adminis- 
tration of  bath  boys  who  know  nothing  of  patholog},  and  for  that 
reason  cannot  intelligently  administer  it.  The  carbon  dioxide  baths 
and  graduated  exercise,  that  constitute  the  Schott  system  of  treating 
heart  disease,  are  quite  useful  in  these  cases.  Commence  with 
XaXCX,  100  grammes,  and  HC1  100  c.c,  temperature  95°,  duration 
five  minutes.  The  aim  is  to  lengthen  the  duration,  lower  the  tem- 
perature and  increase  the  CO.  present.  With  this  in  view  we  increase 
the  Xa,CO,  and  HC1  100  grammes  every  other  bath  until  600  to 
800  is  reached.  Every  other  day  increase  the  duration  one  minute 
until  the  patient  remains  in  the  bath  twelve  to  fifteen  minutes.  Lower 
the  temperature  one  degree  every  other  day  until  85°  F.  is  reached, 
beyond  which  point  it  should  not  be  lowered.  The  action  of  this 
bath  is  to  dilate  the  peripheral  vessels  in  the  skin  by  the  irritation 
.that  the  gas  produces ;  to  reduce  blood  pressure,  lighten  the  work  of 
the  heart,  preserve  this  organ  and  produce  the  stimulating  and  tonic 


DISEASES  OE  THE  KIDNEY  AND  BLOOD.  311 

effects  that  follow  in  their  wake.  It  has  a  beneficial  influence  also 
in  removing  dropsy  if  it  exists.  As  an  associative  treatment  the 
author  has  found  massage  and  static  electricity  of  considerable  value. 
Some  cases   demand  nitroglycerine,  digitalis  and   Basham's  mixture. 

Uremia. 

Uremic    poisoning    is    a    term    applied    to    a     group    of    nervous 
symptoms  produced  by  the  retention  in  the  blood  of  excrementitious 
substances   normally  excreted  by  the   kidney.     The  condition  arises 
most  frequently  during  acute  and  chronic  nephritis,  and  is  due  to  a 
failure  on  the  part  of    the  kidney  to  eliminate  some  or  all  of    the 
poisonous  elements  that  enter  into  the  composition  of  the  urine.     Its 
import  is  grave,  depending  on  the  chronicity  of  the  cause.     The  pro- 
dromal stage  should  be  the  signal  for  immediate  attention.     Withhold 
all  food  and  move  the  bowels   freely  by  catharsis.     Immediate  free 
perspiration  should  be  secured,  and  to  this  end  we  have  access  to 
three  procedures.     Where  the  patient  is  confined  to  bed  we  may  use 
the  hot  full  dry  pack  or  the  hot-air  bath  administered  in  bed.     Where 
the  patient  is  up  and  able  to  have  access  to  sanatorium  treatment  the 
superheated  dry  hot  air  applied  to  the  entire  body  at  a  temperature 
from  200°   to  300°   F.    for  twenty  to  thirty  minutes  will  be   found 
most  effective,  and,  in  the  author's  opinion,  the  most  certain  measure 
against  this  condition.    No  matter  what  measure  to  secure  perspiration 
is  utilized,  it  should  be  followed  by  a  very  brief  tonic  cooling  measure, 
taking  care  to  avoid  chilling.       In  bed-ridden  cases  use  the  sponge 
and  in  ambulatory  cases  the  rain  bath  at  70°  F.  for  one-fourth  minute. 
These  treatments  may  be  applied  once  or  twice  daily,  and  between 
them   the    fomentation   over   the   lumbar   region   at    140°    F.    for   ten 
minutes  and  repeated  every  hour.     The  patient  should  be  urged  to 
drink  freely  of  hot  water,  lavage  of  the  stomach  practiced  and  high 
enemata  of  hot  saline  administered  at  least  twice  daily.     Where  this 
does   not   seem  to  prove   effective,   resort  should   be   had   at   once   to 
hypodermocylsis,   administering   seven   to  ten   ounces   of    hot  saline. 
During  the  entire  time  that  we  are  utilizing  the  above  measures  we 
should    employ   the    precordial    compress    over    which    an    ice-bag   of 
sufficient  size  has  been  placed  to  embrace  the  heart  and  lower  third 
of  the  sternum..    The  influence  of  this  last  application  is  to  strengthen 
the   heart   action   and   by   reflex   influences   stimulate   the   circulation, 
flush  the  kidney  with  arterial  blood,   favor  abundant  elimination  of 
both  water  and  toxins.     The  after-treatment  is  that  of  chronic  ne- 
phritis. 

Nephroptosis— Floating  Kidney. 

See  "Splanchnoptosis." 


312  PRACTICAL  HYDROTHERAPY. 

Renal  Colic. 

Renal  colic  results  from  the  passage,  or  attempted  passage,  of  a 
calculus  or  gravel  from  the  pelvis  of  the  kidney  through  the  ureter, 
and  is  characterized  by  agonizing  pain  in  the  back,  retraction  of  the 
testes,  vesical  irritability  with  sudden  termination  of  the  pain.  The 
calculi  are  formed  by  concentric  lamination  with  some  foreign  body 
acting  as  a  nucleus.  The  Roentgen  ray  is  a  fairly  satisfactory  aid 
in  diagnosis.  During  the  attack  our  immediate  aim  should  be  the 
complete  relaxation  of  the  patient  and  the  relief  of  pain.  This  can 
best  be  accomplished  by  the  drinking  of  very  hot  water,  the  use  of 
the  hot  enema  and  the  hot  full  bath  as  hot  as  it  is  possible  for  the 
patient  to  stand.  Higher  temperatures  can  be  secured  if  cold  is 
applied  to  the  head  and  an  ice-bag  to  the  heart.  An  excellent  method 
is  to  just  submerge  the  body  in  the  very  hot  water  without  the  water 
touching  the  ice-bag  upon  the  heart.  After  the  removal  of  the 
patient  to  bed  very  hot  fomentations  at  140°  F.  may  be  applied  to 
the  lumbar  region  for  ten  minutes,  repeated  every  thirty  minutes  as 
may  be  needed.  Morphia  is  oftentimes  necessary.  Between  the 
attacks  treat  the  underlying  condition,  which  is  usually  that  of  gout 
or  lithemia.  Care  should  be  exercised  to  avoid  overeating  and  the 
use  of  alcohol.  Free  drinking  of  water,  the  use  of  Vichy  water  and 
the  citrate  and  carbonate  of  potassium  are  to  be  recommended. 
These  cases  are  nearly  always  surgical  in  their  aspect,  and  the  treat- 
ment above  outlined  is  temporizing  only  in  its  results.  In  any  event, 
the  surgeon  should  be  consulted  with  regard  to  each  case  of  this 
character. 

Anemia;  Chlorosis. 

These  are  symptomatic  disorders  of  the  blood,  characterized  by 
a  deficiency  of  some  of  its  principal  constituents,  especially  the  red 
corpuscles  and  hemoglobin,  which  are  gradually  reduced.  These  are 
pale  people,  who  are  affected  with  many  nervous  symptoms,  cardiac 
palpitation  and  bruits,  and  oftentimes  menstrual  disorders.  They 
originate  in  those  who  have  suffered  great  loss  of  blood,  who  are 
the  subjects  of  overwork,  anxiety  and  grief,  who  are  housed  and  lack 
bodily  exercise,  who  are  compelled  to  remain  in  badly  ventilated  and 
overheated  offices  and  schools.  In  young  girls  they  frequently  arise 
from  an  unequal  development  of  various  physiological  functions. 
Many  are  the  subjects  of  splanchnoptosis.  In  a  somewhat  extended 
experience  it  is  my  personal  opinion  that  the  greatest  number  of  these 
cases  originate  in  diseases  of  the  digestive  organs,  generally  accom- 
panied by  a  relaxation  of  muscular  fiber.  They  fail  to  digest  and 
assimilate,  are  the  subjects  of  marked  toxemia,  of  ptomaines  and 
leucomaines  arising  from  the  digestive  tract,  as  well  as  the  retained 
waste  products  of  tissue  change.     Such  cases,  as  a  rule,  have  suffered 


DISEASES  OF  THE  KIDNEY  AND  BLOOD.  313 

from  chronic  constipation  for  years,  paying  little  or  no  attention  to 
the  calls  and  necessities  of  nature.  It  is  to  this  class  that  Sir  Andrew 
Clark  has  given,  in  my  opinion,  the  apt  designation,  "fecal  anemias." 
Hydrotherapy  is  as  nearly  a  panacea  for  the  treatment  of  these  cases 
as  exists  in  medicine.  When  we  stop  to  reflect  that  this  agent  stimu- 
lates the  nervous  centers  and  gives  to  them  increased  tone,  rouses 
the  temporarily  dormant  vital  powers,  deepens  the  respiration,  in- 
creases the  absorption  of  oxygen  and  the  elimination  of  carbon 
dioxide,  stimulates  the  appetite  and  digestion,  increases  assimilation 
and  absorption,  overcomes  digestive  disorders,  relieves  constipation, 
improves  and  increases  the  blood  and  lymphatic  circulations,  betters 
muscular  tone  over  the  entire  body,  enhances  tissue  change  ami  in- 
creases excretion,  it  is  no  wonder,  then,  that  it  soon  overcomes  anemia 
and  chlorosis  and  restores  the  body  to  vibrant  health  and  strength. 
We  should  first  seek  in  the  treatment  of  this  disorder  for  causal 
factors.  Fresh  air  is  beneficial,  and  so  is  moderate  exercise,  but  care 
should  be  taken  to  avoid  overexertion  in  these  cases,  as  they  do  not 
stand  it  well.  Breathing  exercises  are  of  great  value  to  these  patients. 
Where  the  case  is  weak  and  bed-ridden  we  may  commence  with  the 
full  dry  pack,  followed  by  the  cold  sponge  at  70°  F.,  reduced  two 
degrees  daily  until  50°  F.  is  reached.  This  treatment  is  to  be  followed 
by  genera!  friction  after  the  entire  body  has  been  carefully  rubbed 
down.  As  soon  as  the  strength  and  reaction  are  somewhat  developed 
we  may  administer  the  dripping  sheet  at  70°  F.  for  three  minutes 
with  vigorous  friction,  having  the  patient  stand  in  a  very  hot  foot- 
bath. The  best  time  for  this  is  in  the  early  morning,  while  the 
patient  is  warm  in  bed,  the  collection  of  heat  upon  the  surface  favoring 
reaction.  When  this  point  has  been  reached  it  will  be  found  that  the 
full  wet  pack  at  65°  F.  for  half  to  one  hour,  followed  by  the  half 
bath  at  70°  F.  for  one  minute,  may  be  instituted.  Decrease  the 
temperature  of  the  bath  two  degrees  daily  and  lengthen  the  time  a 
half  minute  until  the  temperature  of  60°  F.  and  duration  of  three 
minutes  has  been  obtained.  In  ambulatory  cases  we  may  administer 
the  electric  light  bath  or  hot-air  bath  until  commencing  perspiration. 
Follow  this  with  the  circular  or  horizontal  rain  bath  at  102°  F.  for 
one  and  a  half  minutes,  pressure  twenty  pounds,  dropping  the  tem- 
perature to  70°  F.  for  fifteen  seconds.  Reduce  temperature  one  de- 
gree daily  to  60°  F.  and  increase  pressure  one  pound  daily  until 
thirty  is  registered.  At  this  point  we  may  place  the  patient  upon  full 
treatment,  the  following  being  the  best,  in  the  opinion  of  the  author: 
Electric  light  bath  until  commencing  perspiration,  followed  by  the 
rain  bath  at  104°  F.  for  one  and  one-half  minutes,  jet  douche  to  the 
spine  at  60°  F.  for  one-fourth  minute,  fan  douche  at  60°  F.  to  entire 
body,  pressure  twenty  pounds,  gradually  increased  to  thirty.  It  is  the 
author's  opinion  that  the  electric  light  bath  is  by  far  the  most  valuable 


314  PRACTICAL  HYDROTHERAPY. 

of  all  heating  procedures,  not  only  acting  as  a  stimulant  per  se,  but 
seeming  to  bring  out  more  vigorous  corpuscular  response.  Under 
its  use  the  hemoglobin  rapidly  increases.  It  is  a  good  plan,  especially 
in  toxic  cases,  to  permit  the  patient  to  perspire  freely  every  third 
day. 

Certain  rules  should  govern  the  administration  of  hydrothera- 
peutic  measures  in  these  disorders,  among  which  may  be  mentioned 
the  avoidance  of  the  reduction  of  body  temperature  and  to  exercise 
care  to  increase  the  heat  upon  the  surface  before  applying  any  cold 
measure.  We  can  obtain  in  anemics  the  best  and  most  vigorous 
nervous  stimulation  by  very  brief  cold  applications  under  consider- 
able pressure,  owing  to  the  percutient  stimulation.  Many  of  these 
cases  suffer  from  insomnia,  and  should  this  occur  the  neutral  bath 
for  thirty  to  sixty  minutes,  or  the  hot  and  cold  sponge  to  the  spine, 
will  promptly  relieve  the  condition.  For  the  cardiac  palpitation 
nothing  equals  the  precordial  compress  and  ice-bag.  It  goes  without 
saying  that  certain  medicinal  measures  should  accompany  the  admin- 
istration of  hydrotherapy,  the  author  expressing  a  preference  for 
Blaud's  mass  in  large  doses  and  the  various  forms  of  arsenic,  es- 
pecially the  acid  and  Fowler's  solution. 

Pernicious  Anemia;     Splenic  Anemia;     Leukocythemia;     Hodgkins' 

Disease. 

Pernicious  anemia  is  a  progressive  form  which  tends  toward  a 
fatal  issue.  Its  treatment  and  management  is  the  type  of  method  to 
be  pursued  with  the  other  forms  enumerated  above.  Their  cause  is 
unknown,  but  it  follows  pregnancy  and  lactation  with  great  frequency, 
and  is  usually  supposed  to  be  due  to  a  breaking  down  of  the  cor- 
puscles or  some  defect  of  hemogenesis,  possibly  brought  about  through 
some  intestinal  toxin  or  micro-organism.  There  are  a  certain  number 
of  cases  that  are  curable,  and  in  these  arsenic  is  the  remedy — Fowler's 
solution,  from  three  to  forty  minims  per  diem.  Hydrotherapy  can 
materially  aid  in  improving  the  general  nutrition  and  enhancing  the 
effect  of  the  arsenic.  We  should  at  once  correct  any  gastric  trouble 
present,  and,  if  necessary,  use  lavage,  being  careful  to  do  so  in  the 
morning  before  breakfast,  so  as  to  rob  the  patient  of  no  nutriment. 
Intestinal  antisepsis  is  an  important  indication,  and  to  secure  this, 
thymol  has  been  found  to  be  the  best  in  these  cases.  The  writer  has 
also  used  permanganate  of  potassium  covered  with  a  coating  insoluble 
in  the  gastric  juices.  The  diet  should  be  simple,  plain,  concentrated 
and  nutritious,  at  times  predigested.  Free  water-drinking,  high 
enemata  and  hypodermoclysis  of  normal  saline  solution  have  all  been 
found  useful.  For  the  improvement  of  appetite  we  may  employ  the 
ice-bag  over  the  stomach  for  thirty  minutes  before  meals.  The 
general  application  found  most  satisfactory  has  been  the  electric  light 


DISEASES  OF  THE  KIDNEY  AND  BLOOD.  315 

for  three  to  five  minutes,  or  until  perspiration  commences,  followed 
by  the  rain  bath  at  100°  F.  for  one  and  one-half  minutes,  reduced 
to  70°  F.  for  one-half  minute.  Reduce  the  temperature  one  degree 
daily  until  60°  F.  is  reached  and  maintain  the  pressure  uniformly  at 
twenty  pounds.  These  cases  do  not  stand  strong  douches  or  much 
cold,  and  are  cases  that  must  be  closely  watched  and  reaction  secured. 
The  baths,  as  a  rule,  should  be  given  every  other  day  until  the  patient 
begins  to  improve,  when  they  may  be  administered  every  day. 


CHAPTER  XVI. 
DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 

Pericarditis;  Endocarditis;  Myocarditis. 

Pericarditis  is  an  inflammation  of  the  serous  covering  of  the  peri- 
cardium of  the  heart.  It  may  he  primary  or  secondary,  acute  or 
chronic.  In  some  cases  it  runs  its  course  unsuspected,  at  times  is 
difficult  of  diagnosis,  at  other  times  self-evident.  It  is  especially 
prone  to  occur  during  rheumatic  attacks,  the  heart  sounds  appearing 
near  the  ear  and  limited  in  number.  The  disease  of  itself  calls  for 
and  demands  absolute  bodily  rest  in  bed,  with  freedom  from  worry 
and  excitement;  laxatives,  especially  salines,  should  be  administered. 
The  diet  must  be  concentrated,  nutritious,  liquid.  The  ice-bag  applied 
over  a  precordial  compress  acts  as  a  powerful  antiphlogistic,  quieting 
cardiac  action  and  mitigating  the  severity  of  the  pain.  There  is  no 
danger  in  the  proper  use  of  the  ice-bag,  and  it  may  be  continued  for 
weeks  without  any  injurious  or  unpleasant  secondary  effects.  From 
time  to  time  it  should  be  removed  and  the  precordium  rubbed  with  a 
dry  crash  towel.  The  ice-bag  can  be  alternated  with  the  precordial 
compress  at  60°  F.  In  the  chronic  stage  of  the  trouble  we  may  have 
recourse  to  the  full  wet  pack  at  60°  to  65°  F.  for  a  half  to  one  hour, 
care  being  taken  to  place  the  ice-bag  over  the  heart  during  the  admin- 
istration of  the  pack. 

Endocarditis  is  an  inflammation  of  the  membrane  lining  the 
cavities  of  the  heart,  accompanied  by  pain,  precordial  distress  and 
disturbed  cardiac  action.  This  inflammation  influences  mostly  the 
valves  of  the  heart,  producing  a  systolic  apical  murmur.  It  is  often 
the  origin  of  emboli,  and  the  harm  that  it  does  is  usually  to  lay  the 
foundation  for  ultimate  failure  of  integrity  of  the  valvular  structures 
or  cause  serious  embolic  attacks,  the  worst  of  which  are  those  in  the 
cerebrum.  It  is  usually  secondary  to  some  other  disease,  especially 
the  infectious  fevers,  rheumatism,  etc.  Bacteria  are  usually  found 
in  the  lesions.  Slight  cases  recover  without  much  damage,  malignant 
ones  die.  The  aim  should  be  in  therapeutics  to  quiet  the  heart  and 
conserve  its  tissue  as  much  as  possible.  To  do  this  absolute  bodily 
rest  is  essential,  care  being  taken  to  not  even  lift  the  patient  up  in  bed. 
The  diet  must  be  liquid,  easily  digested,  mostly  milk.  In  this  disease 
the  ice-bag  or  cold  compress  at  60°  F.  must  be  kept  constantly  to  the 
heart,  although  it  is  an  excellent  plan  to  remove  the  ice-bag  every  half 
to  one  hour  and  apply  friction  to  the  precordium.  There  is  no  danger 
in  the  ice-bag,  which  may  remain  on  for  days,  having  been  found  to 
(316) 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.       317 

calm  the  patient,  relieve  the  dyspnea  and  oppression.  No  other  hydro- 
therapeutic  treatment  during  the  acute  stage  should  he  instituted. 

Chronic  endocarditis,  usually  a  sequel  of  the  acute  form,  may 
develop,  however,  in  a  healthy  valve,  being  caused  by  habitual  mus- 
cular overexertion,  gout,  alcohol,  etc.  The  valves  become  deformed 
and  thickened.  The  patient  in  the  chronic  stage  must  be  gradually 
trained  to  hydriatic  measures.  Place  the  case  in  a  full  dry  pack, 
followed  by  the  cold  sponge  at  70°  F.,  applied  only  to  the  upper  and 
lower  extremities  for  the  first  two  days  ;  this  in  turn  to  be  succeeded 
by  the  ice-bag  to  the  heart  for  one  or  two  hours.  The  next  two  days 
we  may  administer  the  cold  sponge  to  the  entire  body,  and  as  soon  as 
the  patient  responds  well  to  this  treatment  we  may  then  apply  the 
dripping  sheet  at  70°  F.  for  one  minute  with  vigorous  friction,  followed 
by  the  ice-bag  to  the  heart  for  one  hour;  increase  the  duration  half  a 
minute  until  the  maximum  period  of  three  minutes  is  reached ;  reduce 
the  temperature  one  degree  daily  until  65°  F.  is  reached.  In  con- 
nection with  the  dripping  sheet,  general  massage  will  be  found  to  be 
of  great  benefit.  At  this  stage  the  Schott  exercises  may  be  commenced 
and  the  patient  gradually  advanced  along  this  line. 

In  myocarditis  caution  must  be  used  in  the  application  of  the  ice- 
bag  and  high  altitudes  avoided.  The  same  cautions  with  reference  to 
the  use  of  the  carbon  dioxide  baths  and  Schott  exercises  in  arterio- 
sclerosis apply  with  equal  force  to  myocardial  inflammations. 

Treatment  of     Chronic  Organic     Disease  of     the  Heart  and     Blood 

Vessels. 

There  are  certain  general  rules  and  laws  applicable  to  all  forms 
of  diseases  of  the  heart  and  blood-vessels,  and  in  order  to  avoid  useless 
repetition  the  author  will  first  lay  down  these  general  principles  and 
rules  for  the  guidance  of  patients,  will  enumerate  the  various  methods 
of  therapeutics,  their  uses  and  advantages,  and  will  then  consider  the 
special  diseases  in  which  they  are  applicable.  Many  cases  will  be 
found  in  which  one,  two  or  even  more  lesions  are  present  at  the  same 
time,  and  it  is  here  that  the  practitioner  who  follows  this  line  of  ther- 
apeutics will  have  to  use  his  sound  judgment  based  upon  the  well- 
known  principles  of  this  therapy.  Prescribing  for  cardiac  cases 
requires  us  to  mix  some  brains  with  the  prescription  if  success  is 
desired,  and  as  this  field  is  by  far  the  most  promising  and  certain 
of  all  methods  known  at  the  present  day  for  the  purpose  of  relieving 
these  diseases,  it  behooves  the  student  and  physician  to  carefully  study 
and  consider  the  methods  to  be  employed.     Schott1  very  clearly  stated 

1  Schott,  Theo. :  "The  Treatment  of  Chronic  Diseases  of  the  Heart  by  Means  of  Baths 
and  Gymnastics,"  London  Lancet,  Vol.  I,  p.  1143,  1891;  "The  Mineral  Waters  of  Nauheim, 
Their  Uses  and  Effects,"  1894;  "Balneo-Therapeutics  and  Mechano-Therapeutics  Applied  to 
the  Treatment  of  Chronic  Heart  Disease,"  New  York  Medical  Record,  1891;  "Chronic  Dis- 
eases of  the   Heart,"   New  York   Medical   Record,   June  29,    1901. 


318  PRACTICAL  HYDROTHERAPY. 

that  benefit  may  be  expected  to  accrue  in  all  cases  of  chronic  heart 
disease,  whether  of  valvular  or  parietal  incidence,  except  where  the 
myocardium  has  reached  an  advanced  stage  of  degeneration  or  the 
vessels  are  the  seat  of  aneurisms  or  far-advanced  arterial  sclerosis. 
It  becomes  a  matter  of  indifference  whether  the  incompetency  depends 
upon  valve  lesions,  muscle  disease,  or  is  the  result  of  general  dis- 
turbances of  nutrition  or  disease  of  the  vessels,  thus  making  it  suitable 
for  all  forms  of  chronic  heart  disease,  neuroses  of  the  heart,  Graves' 
disease,  etc.  The  rule  to  govern  prognosis  is  that  the  cardiac  muscle 
must  be  capable  of  response  to  the  stimulus  of  the  baths  and  exer- 
cises in  order  to  be  able  to  undergo  compensatory  hypertrophy. 

Such  a  broad  statement  can  only  be  appreciated  when  one  knows 
the  intellectual  and  scientific  calibre  of  the  man  making  the  statement. 
In  order  to  successfully  achieve  results  the  physician  must  be  in  a 
position  to  devote  a  great  deal  of  time  to  his  patients,  and  they  in 
turn  must  methodically  and  intelligently  obey  his  instructions  to  the 
letter,  taking  sufficient  interest  in  the  "cure"  to  secure  satisfactory 
results. 

In  the  early  stages  of  the  disease  the  physician  himself  must 
superintend  the  administration  of  the  baths,  the  rest  between  them, 
and  should  himself  first  administer  the  resistive  exercises,  for  he  alone 
can  in  bad  cases  judge  of  the  time  required  between  the  exercises  for 
rest. 

There  are  three  aims  in  the  treatment  of  cardiac  disease:  (1) 
Reduce  the  abnormal  systemic  resistance  to  the  column  of  blood  in 
the  general  vascular  system;  (2)  sustain  perfect  functional  cardiac 
activity  for  such  a  length  of  time  as  to  produce  (3)  compensatory 
hypertrophy.  It  should  be  remembered  in  considering  the  first  aim 
we  have  in  view  that  the  capillaries  of  the  human  body  are  the  masters 
of  the  circulation,  and  it  is  to  these  that  we  must  look  for  the  relief 
of  the  abnormal  systemic  resistance,  for  it  may  be  stated  that  the 
greater  the  resistance  of  the  arterial  system  the  greater  the  strain 
upon  the  heart;  overcome  this,  and  we  are  less  likely  to  have  dilata- 
tion. Where  we  secure  active  dilatation  of  the  peripheral  blood- 
vessels we  "lift  the  load"  from  the  laboring  heart,  the  vis  a  fronte  is 
improved,  the  vis  a  tcrgo  strengthened  through  the  thermic  irritation 
that  acts  upon  the  vascular  network  of  the  skin.  This  is  best  accom- 
plished by  general  measures,  as  these  stimulate  the  respiration,  increase 
oxygen  absorption  and  C02  excretion.  As  the  respiration  is  increased 
it  sucks  the  blood  like  a  great  pump  into  the  lung  tissue,  relieving  the 
right  heart,  preventing  venous  stasis  and  returning  the  re-oxygenated 
and  rejuvenated  blood  to  the  left  heart.  It  increases  the  general 
muscular  and  nervous  susceptibility,  relieves  toxemia  and  improves 
the  general  well-being.  Alcohol,  digitalis  and  other  cardiac  stimulants 
do  not  have  to  be  dispensed  with  during  the  use  of  hydrotherapy  in 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.        319 

the  treatment  of  cardiac  disease,  but  where  they  are  demanded  smaller 
and  mure  infrequent  doses  have  to  be  used,  as  the  treatment  seems  to 
develop  an  increased  susceptibility  to  the  action  of  these  drugs. 

Hoffmann2  says  that  much  can  be  learned  from  a  comparison  of 
heart  sounds.  Little  can  he  expected  of  digitalis  when  the  second 
sound  is  weaker  at  the  base  than  the  first  sound.  This  state  of  affairs 
he  calls  the  "cold-water  heart."  and  needs  no  medicinal  management. 
In  these  cases  the  precordial  compress  and  ice-bag  and  the  full  cardiac 
method  of  Schott  are  very  useful.  Deep  breathing  is  of  especial 
assistance. 

In  this  connection  it  may  not  be  amiss  to  say  that  alcohol  dimin- 
ishes the  work  of  the  heart,  but  also  lessens  its  working  power; 
digitalis  increases  the  working  power,  but  increases  the  work  to  be 
accomplished  by  the  heart  by  increasing  peripheral  resistance.  Both 
are  toxic  substances  and  add  to  the  toxemia  present.  Cold  applica- 
tions, on  the  contrary,  increase  the  working  power  of  the  heart, 
diminish  the  work  to  be  done,  eliminate  and  destroy  toxins,  and, 
no  matter  how  long  used  or  how  protracted,  do  not  diminish  cardiac 
susceptibility.  Even  where  drugs  fail  the  heart  will  oftentimes  give 
prompt  response  to  hydriatic  measures,  and  where  we  find  that  the 
heart  fails  to  respond  to  cardiac  stimulants  and  yet  responds  to  hydro- 
therapy, then  a  favorable  prognosis  as  to  the  continuance  of  life  and 
to  improvement,  even  though  temporary,  may  be  given,  though  the 
results  are  more  often  permanent.  Local  cold  stimulates  the  heart 
muscle  and  strengthens  its  contractions,  and  this  continues  for  a  long 
time  after  removal  of  the  application  itself.  Local  applications  may 
be  used  to  supplement  the  invigorating  action  of  general  measures. 
Carbon  dioxide  baths  increase  the  vascular  capacity  by  dilating  the 
arterioles,  lessening  the  heart's  work  by  diminishing  the  peripheral 
resistance,  the  pulse  becoming  slower  after  the  baths  and  exercises 
than  before  them,  the  arteries  fuller.  The  dilated  heart  shows  a 
smaller  area  by  percussion  due  to  diminished  amount  of  blood  in  the 
heart  chambers  and  to  the  better  cardiac  contraction.  As  the  baths 
are  repeated  the  speed  of  the  heart  in  the  interim  progressively 
diminishes  until  a  normal  rate  is  reached.  They  should  always  be 
succeeded  by  a  rest  of  one  or  two  hours.  Their  action  is  to  lessen 
the  frequency  of  cardiac  contraction,  increase  diastole,  shorten  and 
improve  systole  and  thus  bring  about  better  cardiac  nutrition. 

The  general  law  may  be  stated  that  hot  baths  weaken  the  heart, 
cold  baths  strengthen.  Where  it  becomes  necessary,  then,  to  use 
sweating  measures  and  cardiac  complications  contraindicate  their  use, 
we  may  employ  the  electric  light  bath  or  superheated  dry  hot  air  in 
the  reclining  position  with  ice-bag  to  the  heart,  or  the  heating  pro- 
cedures to  the  lower  limbs  alone.     General  cold  friction  is  one  of  the 

2  Berliner  klin.  Wochenschrift,  No.   14. 


320  PRACTICAL  HYDROTHERAPY. 

best  measures  for  cardiac  stimulation,  as  complete  general  reaction 
is  secured  without  the  displacement  of  blood  to  the  interior. 

Summing  up  the  advantages  of  hydrotherapy,  we  may  say  that  it 
invigorates  the  heart's  action,  enlarges  the  volume  of  the  pulse,  better 
fills  the  arteries,  lessens  irregular  heart  action,  reduces  the  resistance 
in  the  general  arterial  system,  deepens  respiration,  favors  the  absorp- 
tion of  any  exudates  that  may  exist,  and  gives  to  the  heart  increased 
power  with  diminished  work.  The  author  has  found  in  treating  this 
class  of  cases  that  it  is  oftentimes  best  to  commence  the  course  with 
the  use  of  massage  one  day.  the  baths  the  next,  and  at  the  end  of  two 
weeks'  treatment  commence  with  the  resistive  exercises.  These  baths 
must  be  applied  with  some  system  and  with  a  view  to  the  condition 
of  the  patient,  it  being  well  to  commence  with  a  small  amount  of 
saline  and  gradually  increase. 

In  administering  the  exercises  more  care  and  attention  is,  in  the 
author's  opinion,  required  for  success  than  in  the  administration  of 
the  baths.  Exercises  of  any  kind  are  contraindicated  in  the  early 
stages  of  valvular  disease,  and  should  never  be  administered,  as  at 
this  time  absolute  rest  is  indicated.  When  this  state  has  passed  the 
question  of  their  use  arises.  They  are  indicated  up  tr>  the  time  com- 
pensation is  established,  but  exercise  should  not  at  this  period  be 
discontinued.  To  put  it  more  clearly,  Schott's  system  is  to  be  pursued 
under  strict  medical  supervision,  together  with  the  carbon  dioxide 
baths,  until  compensation  takes  place,  to  be  followed  by  a  gradual 
system  of  after-treatment  of  moderate  exercise,  preferably  hill- 
climbing,  using  the  system  laid  down  by  Prof.  Oertel,  the  changes 
and  gradations  being  governed  by  the  medical  attendant.  Compen- 
sation once  established,  exercise  must  still  be  taken,  although  strain 
or  sudden  violent  exertion  is  to  be  avoided.  Heart  cases,  as  a  rule, 
take  too  little  exercise,  and  they  should  be  stimulated  in  this  regard. 
Active,  strenuous  and  restless  patients  must  be  watched  and  guided, 
while  the  sluggish,  timid  and  fearful  ones  must  be  urged  to  strive 
more  actively.  The  patient  should  know  his  trouble  in  the  right  way, 
for  he  holds  the  result  in  his  own  hands.  From  the  date  of  recovery 
he  will  have  to  adjust  his  mode  of  life  to  his  condition,  and  this 
will  require  an  intelligent  conception  of  his  own  case.  It  is  a  good 
plan  for  such  patients  to  keep  themselves  under  restraint  until  the 
restraint  becomes  a  habit ;  they  should  be  deliberate  in  movements, 
avoid  dancing,  running  for  cars  and  muscular  strains,  keep  all  their 
passions  under  perfect  control,  mentally  as  well  as  bodily.  The  best 
forms  of  exercise  are  those  that  are  taken  in  the  open  air.  but  if  this 
cannot  be  obtained  exercise  should  be  taken  when  and  where  it 
can.  For  middle-aged  and  elderly  people,  riding  and  golf  are  the  best 
forms ;  for  the  young  and  vigorous  we  may  allow  them  within  limits 
to   ride  the  bicycle,   swim,  play  tennis  and  baseball.      Breathlessness 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.        321 

and  palpitation  are  the  danger-signals  all  must  watch.  Cheerful 
surroundings,  pleasant  company,  the  gentle  intellectual  stimulus  of 
pleasant  conversation,  entertaining  reading  and  good  music  are  found 
to  be  beneficial  to  these  cases.  Their  clothing  must  be  adopted  to 
suit  the  season,  and  where  financially  able  they  should,  in  winter, 
seek  the  balmy  air  of  Florida  or  lower  California,  and  in  summer  the 
cool  and  stimulating  breezes  of  Michigan  and  Maine  in  this  country. 
There  are  certain  measures  that  are  dangerous  to  those  suffering  from 
organic  heart  disease  and  should  never  be  employed. 

The  baths  that  are  contraindicated  are  the  full  cold  bath,  cold 
jet,  hot-air  bath,  superheated  dry  hot  air,  Turkish  bath,  Russian  bath, 
full  hot  bath,  or  prolonged  baths  of  any  kind.  It  must  be  borne  in 
mind,  however,  that  the  electric  light  bath  and  superheated  dry  hot 
air  may  be  at  times  administered  with  the  use  of  the  ice-bag  to  the 
precordium. 

Schott  Resistive  Gymnastics. 

The  movements  are  all  gentle,  "resistive"  gymnastics,  the  slight  re- 
sisting force  employed  being  supplied  either  by  the  attendant  or  by 
the  patient's  own  muscles.  The  former  is  the  better  plan.  In  the 
latter  method  the  patient  makes  a  gradual  effort  of  contraction  of 
certain  sets  of  muscles,  at  the  same  time  resisting  the  contraction  with 
the  opposing  groups  of  muscles,  this  increasing  the  work  done.  For 
example,  instead  of  freely  and  slowly  flexing  the  arm,  the  extensor 
groups  are  called  into  action  to  resist  the  flexors  to  the  needed  extent. 
This  should  only  be  permitted  in  patients  of  intelligence  and  quick 
apprehension,  and  not  in  them  until  the  ordinary  resistance  by  a  phy- 
sician or  an  attendant  has  been  used  often  enough  to  demonstrate 
to  them  how  the  work  is  done  and  what  amount  of  resistance  should 
be  offered.  To  use  "self-resistance"  properly  requires  a  little  practice 
to  acquire  control  of  the  separate  muscle-groups.  The  exercises  be- 
gin with  simple  movements,  and  are  so  arranged  as  to  bring  into  service 
in  succession  nearly  every  group  of  muscles  in  the  whole  organism. 
The  movements  are  made  very  slowly,  with  a  steady  uniform  motion, 
and  with  a  short  interval  of  rest  (fifteen  to  thirty  seconds)  after 
each;  no  movement  is  repeated  twice  in  succession.  If  there  is  the 
slightest  sign  of  dyspnea  or  increased  speed  of  breathing  or  pulse 
the  least  tendency  to  cyanosis,  sweating  or  palpitation,  the  movements 
should  be  stopped  at  once,  and  if  relief  is  not  experienced  the  patient 
must  lie  down  for  a  few  minutes.  The  clothing  should  be  loose 
everywhere,  that  there  may  be  no  interference  with  the  peripheral 
circulation. 

The  patient  must  not  be  allowed  to  think  that  the  exercises  are 
intended  to  effect  any  muscular  development.  In  weak  persons  some 
gain  in  this   direction  may  incidentally  be  made,  but  the  object  in 


322  PRACTICAL  HYDROTHERAPY. 

view  is  to  produce  certain  results  upon  the  heart  and  blood-vessels, 
and  this  should  be  brought  about  with  an  almost  inappreciable  amount 
of  muscular  exertion,  certainly  without  enough  to  fatigue. 

The  patient  may  either  sit  or  stand  during  the  exercise,  according 
to  his  strength,  but  some  of  the  movements,  it  will  be  seen,  must  be 
performed  standing.  The  person  in  charge  stands  facing  the  patient 
or  beside  him,  as  may  be  needed,  and  makes  gentle  resistance  to  each 
movement.  It  is  important  that  the  attendant's  resisting  force  should 
be  used  in  such  a  manner  as  not  to  impede  the  circulation  in  any  of 
the  vessels ;  the  hand  should  either  be  applied  to  the  part  pressed  upon 
with  purely  flat  pressure,  or.  if  it  be  necessary  to  grasp  a  limb,  this 
should  be  done  with  a  light,  not  a  close,  grasp ;  the  member  should 
not  be  encircled  by  the  hold.  When  the  movements  are  for  any 
reason  intermitted,  there  must  be  no  sudden  change,  and  the  patient's 
limb  must  be  >upported  by  the  attendant  in  its  return  to  an  easy  po- 
sition. 

The  movements  are  as  follow^ : 

1.  The  patient,  standing  or  sitting,  extends  the  arms  forward 
level  with  the  shoulders,  palms  together,  hands  held  slightly  open. 
The  attendant  puts  his  open  hands  on  the  dorsal  aspect  of  the  patient's 
wrists  and  makes  light  pressure,  while  the  patient  slowly  separates 
the  arms  until  they  are  in  transverse  line  with  the  shoulders.  The 
attendant  then  shifts  his  hands  to  the  palmar  aspect  of  the  patient's 
wrists  and  makes  light  resistance  while  the  arms  are  returned  to  the 
original  forward-extended  position. 

2.  With  the  hand  hanging  by  the  side,  the  attendant  supports  the 
arm  above  the  elbow  with  one  hand.  The  patient  flexes  the  forearm 
without  moving  the  upper  arm,  until  the  thumb  touches  the  shoulder, 
the  operator's  other  hand  resisting  with  pressure  against  the  flexor 
surface  of  the  wrist.  The  reverse  movement  of  extension  of  the 
forearm  is  similarly  resisted  with  pressure  against  the  dorsal  aspect 
of  the  wrist,  the  upper  arm  all  the  while  steadied  by  the  attendant's 
gentle  grasp. 

3.  The  arms  hanging,  palms  forward,  are  abducted  and  elevated 
until  the  thumbs  touch  above  the  head,  the  attendant  making  resistance 
upon  the  radial  aspect  of  the  wrists ;  the  arms  are  then  returned  to 
the  original  position,  with  resistance  to  the  ulnar  side  of  the  wrists. 

4.  The  hands,  with  the  fingers  intertwined,  palms  toward  the  body, 
are  held  at  the  level  of  the  abdomen  and  then  raised  until  they  are 
above  the  head,  resistance  being  made  to  the  radial  aspects  of  the 
wrists.  In  the  return  the  attendant  receives  the  wrists  in  the  fork 
between  the  thumb  and  forefinger,  with  the  backs  of  his  hands  toward 
the  patient. 

5.  The  hands  hang  by  the  sides,  thumbs  forward,  palms  against 
the   thighs       They   are   raised    forward    and    upward    with   the   arms 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.       323 

straight  and  parallel  until  they  arc  extended  above  the  head.  The 
motion  is  then  reversed.  The  attendant's  hands  must  make  sev- 
eral changes  of  position  to  keep  up  a  steady  resistance  during  this 
movement,  his  fingers  at  first  merely  pressing  the  radial  surface  of 
the  patient's  wrist,  then,  as  the  arms  are  raised,  lightly  clasping  the 
wrist  with  his  fingers.  During  the  downward  movement  the  wrists 
are  first  received  as  in  4,  in  the  fork  of  the  hand;  then,  when  the 
patient's  arms  are  level  with  the  shoulders,  the  ulnar  aspect  of  the 
patient's  hand  and  wrist  should  rest  upon  the  forefingers  and  thumb 
of  the  attendant,  and,  finally,  the  downward  motion  is  resisted  by 
the  fingers  of  the  attendant  gently  clasping  the  ulnar  aspect  of  the 
patient's  wrists.  The  resistance  to  this  movement,  Dr.  Bezly  Thorne 
says,  "is  the  operator's  pons  asinoriun,  but  it  should  be  mastered." 

6.  The  body  is  bent  forward  from  the  waist  and  then  straightened 
up ;  resistance  to  the  bending  is  made  with  a  hand  on  the  upper  ster- 
num and  to  the  recovery  of  the  erect  posture  by  a  haud  on  the  upper 
dorsal  spine,  the  attendant  standing  beside  the  patient. 

7.  The  body  is  rotated  from  the  waist,  without  moving  the  hips 
or  feet,  first  to  one  side  and  then  to  the  other,  then  returning  to  the 
original  position.  To  resist  this,  one  hand  is  applied  flat  upon  the 
advancing  shoulder  over  the  claviculo-humeral  junction,  the  other 
clasped  over  the  shoulder  which  is  being  drawn  back.  The  attendant 
will  find  it  necessary  to  move  one  or  two  steps  sidewise  to  maintain 
his  relation  to  the  patient. 

8.  The  trunk  is  bent  sidewise  as  far  as  possible  without  moving 
the  feet,  to  the  right,  to  the  left,  and  to  the  erect  position  again.  The 
attendant  resists  with  a  hand  in  the  axilla  of  the  downward-moving 
side,  his  other  hand  pressing  firmly  on  the  opposite  hip. 

9.  This  is  a  repetition  of  2,  namely,  flexion  of  the  forearm  only, 
but  in  this  movement  with  the  addition  that  the  hand  is  firmly  clenched 
during  the  motion.  First  one  arm  and  then  the  other  performs  the 
exercise. 

10.  This  is  like  9,  but  with  the  palm  turned  outward.  The  arms 
act  singly  in  succession.     Resistance  is  made  as  in  2  and  9. 

11.  The  arm  starts  from  the  hanging  position,  thumb  to  the  front, 
palm  to  the  side,  and  moves  forward  and  up  to  the  vertical  position. 
The  hand  is  then  turned  palm  down,  and  the  arm  lowered  to  the  side. 
The  attendant  resists  with  one  hand  clasped  about  the  wrist,  substi- 
tuting the  upward  pressure  of  his  free  hand  during  the  descent  of 
the  patient's  arm  from  the  vertical  position. 

12.  The  arms  are  extended  backward  from  the  hanging  position, 
parallel,  as  far  as  possible  without  throwing  the  body  forward,  and 
returned.  Resistance  is  made  with  open-hand  pressure  during  the 
backward  movement,  with  a  light  clasp  of  the  wrists  during  the  re- 
turn. 


324  PRACTICAL  HYDROTHERAPY. 

13.  Standing  by  a  table  or  chair,  upon  which  a  steadying  hand 
may  rest,  the  patient  flexes  the  thigh  on  the  trunk,  and  returns  th^ 
limb  to  its  original  position.  The  movement  is  then  repeated  with  the 
ether  leg.  The  flexion  is  resisted  by  a  hand  upon  the  lower  third  of 
the  thigh,  and  the  return  by  a  hand  under  the  same  part.  Only  the 
thigh  muscles  should  be  brought  into  play  in  this  exercise,  the  leg 
hanging  loosely  from  the  knee. 

14.  From  the  same  position  as  in  13  the  whole  leg  is  extended 
forward  and  upward  and  then  backward.  The  resistance  should  be 
applied  above  the  ankle. 

15.  From  the  same  position  as  in  13  and  14;  or,  supported,  if  un- 
steady, by  both  hands  on  a  chair,  the  patient  bends  the  lower  leg  on 
the  thigh  and  returns  it.  Resistance  is  applied  above  the  heel  to  the 
upward  motion,  in  front  of  the  ankle  to  the  downward  motion. 

16.  Same  position  as  in  13.  The  patient  makes  a  lateral  outward 
movement  of  the  whole  leg  to  the  limit  of  motion,  and  reverses  it. 
Resistance  is  applied  at  the  ankle. 

17.  The  arms,  extended  sidewise  level  with  the  shoulders,  are 
rotated  from  the  shoulder-joint.  The  attendant  resists  by  lightly 
grasping  the  wrist. 

18.  Flexion  and  extension  of  the  hand  are  made  on  the  forearm, 
returning  to  a  right  line  with  the  arm.  The  attendant  supports  the 
arm  at  the  wrist,  and  resists  the  movements  by  pressure  on  the  dorsal 
or  palmar  surface  of  the  hand,  according  to  the  motion. 

Similar  flexion  and  extension  of  the  foot  on  the  leg,  with  appro- 
priate resistance  on  the  dorsal  and  plantar  surfaces,  conclude  the 
series. 

Schott  sums  up  tersely  the  principles  involved  as  follows:  "Unsys- 
tematic exercise  constitutes  a  heart-weakening;  systematic  exercises, 
on  the  contrary,  a  heart-strengthening  treatment." 

Oertel's  System. 

Professor  O.  Oertel,  of  Munich,  published  in  1885  an  elaborate 
original  system  of  treatment  for  ''circulatory  disturbances,  enfeeble- 
ment  of  the  heart  muscle,  incomplete  compensation  in  valvular  lesions, 
fatty  heart,  obesity  and  changes  in  the  pulmonary  circulation"  founded 
upon  ten  years'  observation  of  its  usefulness. 

"The  important  phenomena  (observed  in  disturbances  of  the  cir- 
culation )  are  purely  physical.  It  is  therefore  possible  to  expect  to 
re-establish  the  hydrostatic  equilibrium  by  mechanical  means  and  by 
reducing  the  fluids  of  the  organism.  Afterward,  or  at  the  same  time, 
consideration  can  be  given  to  the  causes  of  the  circulatory  trouble, 
and  especially  to  the  repair  of  the  broken  compensation.  The  most 
important  result,  however,  of  the  new  method  lies  in  the  strength- 
ening of  the  heart-muscle  by  gymnastic  measures,  in  anemia,  in  atrophy 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.        325 

of  the  heart,  in  uncompensated  valvular  lesions,  in  degeneration  and 
fatty  infiltration  of  the  myocardium.'' 

The  Oertel  treatment,  for  its  best  application,  needs  peculiar  cli- 
matic and  topographic  conditions — a  certain  elevation  above  the  sea, 
a  constant,  moderate  climate,  hills  or  mountains,  with  good  paths 
carefully  laid  in  even  and  known  gradients,  and  hotels  under  real 
medical  control,  with  exact  diet  schedules  correctly  carried  out.  It 
is  enough  to  mention  these  requirements  for  any  one  familiar  with  the 
climate  and  resorts  of  the  United  States  to  recognize  at  once  that 
these  conditions  are  not  now  met  in  any  place  in  this  country. 

The  treatment  is  best  carried  out  in  a  moderate  elevation,  1,800 
to  2,200  feet,  as  the  air  is  drier  and  purer  at  such  a  height.  Ascents 
should  carry  the  patient  even  higher  than  this — 3,000  to  3,500  feet 
or  more. 

Exercise  is  as  necessary  to  keep  the  heart-muscles  in  good  condition 
as  it  is  for  any  other  set  of  muscles  in  the  body.  The  first  indication 
is  met,  therefore,  by  working  the  heart,  by  walking,  by  hill-climbing 
in  a  slightly  rarefied  atmosphere,  and,  if  these  do  not  suffice  or  are 
not  available,  by  suitable  gymnastics.  Palpitation  and  breathlessness 
will  naturally  occur,  but  need  cause  no  alarm  unless  very  persistent. 
The  patient  should  be  told,  if  he  suffers  in  this  way,  to  stand  still  and 
breathe  deeply.  He  should  carry  a  stout  stick  and  use  it  as  a  rest, 
thus  fixing  the  shoulders  and  giving  the  chest  muscles  a  point  to 
work  from.  He  should  not  sit  down,  as  breathing  is  less  free  in  this 
position  than  when  erect.  In  two  or  three  minutes  at  most  he  will  be 
able  to  go  on  his  way. 

As  soon  as  exercise  can  be  taken  the  patient  should  walk,  on  the 
flat  or  up-hill,  according  to  his  ability.  It  is  to  be  remembered  always 
that  exertion,  to  have  a  good  effect,  must  go  to  the  pohit  of  producing 
moderate  fatigue.  As  the  strength  improves,  the  length  of  the  walk 
and  the  height  of  the  ascent  should  be  made  greater.  In  brief,  exer- 
cise causes  a  determination  of  arterial  blood  to  the  skin,  sweating 
accompanies  this,  the  venous  pressure,  especially  in  the  renal  vessels, 
is  lowered,  the  cardiac  and  pulmonary  activity  and  the  arterial  pres- 
sure are  increased.  The  anticipated  effects  should  show  themselves 
within  a  reasonable  time — six  or  eight  weeks. 

Compensation  established  by  rest,  and  the  dietetic  matters  regu- 
lated, we  turn  to  exercise  of  the  heart  for  the  completion  of  the  cure 
by  permanent  improvement  in  the  cardiac  power.  The  form  of  exer- 
cise must  be  one  that  can  be  measured  with  exactness,  that  will  make 
no  undue  demands  upon  muscles  as  yet  unable  to  respond  to  them, 
and  yet  will  call  sufficiently  upon  the  heart  and  the  breathing  appa- 
ratus to  produce  the  desired  effect  of  strengthening  them. 

Once  compensation  has  been  fully  regained,  the  heart  must  be 
trained  by  graduated  exercises  to  do  as  much  work  as  it  can  without 


326  PRACTICAL  HYDROTHERAPY. 

injury.  Such  work  does  not  include  sudden  violent  exertion,  hard 
running,  or  the  carrying  of  heavy  weights.  A  person  with  a  heart 
still  weak  from  recent  valvular  disease,  though  competent  for  its  work 
under  ordinary  conditions,  should  not  attempt,  for  example,  to  run 
for  a  train. 

Enough  has  been  said  already  in  speaking  of  the  two  systems  to 
indicate  the  manner  in  which  cases  should  be  selected  for  treatment. 
Patients  with  moderate  degrees  of  incompetence,  or  with  moderate 
dilatation,  and  those  who  suffer  with  functional  tachycardia,  need 
gentle,  increasing,  measured  gymnastic  exercise,  combined,  if  possible, 
with  some  means  which  shall  dilate  peripheral  vessels  enough  to  lessen 
the  heart's  work  in  forcing  the  blood  through  them.  Patients  suffering 
from  fatty  infiltration,  general  obesity,  respiratory  insufficiency  and 
consequent  imperfect  oxygenation,  will  have  their  requirements  best 
met  by  long-continued  moderate  general  exercise,  of  which  the  most 
desirable  form  is  hill-climbing,  sufficiently  severe  to  make  considerable 
demand  upon  the  lungs,  and,  with  this,  there  must  be  a  dietetic  regimen 
in  which  quantity  and  quality  are  adapted  to  individual  needs,  of 
course,  but  generally  of  a  character  suited  to  those  with  a  tendency 
to  accumulate  fat. 

The  resistance  movements  already  described  form  an  excellent 
preparatory  course,  to  which  the  hill-climbing  is  an  invaluable  sequel. 

Chronic  Cardiac  Disease;   Organic  Valvular  Heart  Disease;  Mitral 
Regurgitation;  Aortic  Regurgitation;  Tricuspid  Regurgita- 
tion; Pulmonic  Regurgitation;  Mitral  Stenosis;  Aortic 
Stenosis;  Tricuspid  Stenosis;  Pulmonic  Stenosis; 
Chronic  Myocarditis. 

These  conditions  represent  insufficiency  and  obstruction  to  the 
normal  flow  of  blood  through  the  heart ;  they  are  often  associated 
together  with,  and  most  frequently  have,  endocarditis  as  their  cause. 
Cardiac  dilatation  and  hypertrophy  may  be  present  and  frequently 
determine  the  treatment.  In  the  early  stages  complete  rest  in  bed 
is  essential,  and  the  treatment  laid  down  for  endocarditis  may  be 
followed.  As  the  patient  improves  his  life  should  be  regulated  and 
all  nervous  and  mental  strains,  the  extremes  of  passion,  overwork  and 
excitement  avoided.  The  diet  must  be  simple  and  given  in  small 
amounts,  nutritious,  easily  digested,  principally  nitrogenized ;  the 
thirst  may  be  quenched  with  pure  water  in  small  amounts  taken  fre- 
quently. Carbonated  water  should  be  rather  avoided  or  very  small 
amounts  allowed.  Great  care  must  be  taken  to  avoid  digestive  dis- 
orders, especially  gaseous  distension,  which  impedes  abdominal  res- 
piration and  venous  circulation.  Tea,  coffee,  condiments,  alcohol  and 
tobacco  are  to  be  forbidden.  It  is  in  these  cases  that  the  method  here 
laid  down  has  achieved  some  of  its  greatest  results — that  is  to  say, 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.       127 

the  carbon  dioxide  bath,  commencing  with  a  small  quantity  of  saline 
and  carbonic  acid  gas,  a  higher  temperature  and  shorter  duration,  in 
connection    with   the   exercises.       We   may    follow   the   schedule   of 
Saundby  or  commence  with  a  simpler   formula  of  sodium  carbonate 
and   commercial    11C1;  this  is  the  writer's   favorite  method.     At  the 
end   of    a   week  or  ten   days  we  may  add  the   Schott  exercises,  and 
finally  finish  with  Oertel's  method  if  necessary.     Where  palpitation 
exists  apply  the  ice-bag,  coil  or  cold  compress  over  the  heart.     The 
writer  has  found  massage,  mechanical  vibration  and  the  static  current 
of  some  value  in  the  general  treatment  of  these  cases.     Governed  by 
conditions,  he  uses  strychnine,  digitalis,  nitroglycerine,  arsenic  and  iron. 
The  foregoing  treatment  is  based  upon  the  first  stage  of  the  disease, 
but  where  it  has  progressed  to  the  second,  we  may  then  institute  the 
following  schedule  of  treatment:  If  the  heart  is  very  weak,  put  the 
patient  at  perfect  rest  in  bed,  placing  the  ice-bag  over  the  heart  for 
fifteen  minutes,  gradually  increased  to  thirty,  two  or  three  times  daily. 
As  soon  as  progress  is  made  place  the  patient  in  the  full  dry  pack  for 
thirty  minutes,  followed  by  the  cold  sponge  to  the  upper  and  lower 
extremities;   do  this   for  two   days,   then   twice   daily   for  two   days; 
then  the  full  sponge  twice  daily  at  70°  F.,  followed  by  good  friction. 
At  this  stage  we  can  then  apply  the  dripping  sheet  at  70°  F.  for  one 
minute  with  vigorous   friction;    increase  one-half  minute  daily  until 
three  minutes  is  the  duration.     Each  application  is   followed  by  the 
ice-bag  to  the  heart  for  one  hour.     The  Schott  system  of  exercises 
may  be  used  with  these  bed  patients  with  much  benefit,  care  being 
taken  to  never  give  the  exercises  within  two  hours  of  the  hydriatic 
treatment.     When  the   duration  of  the  dripping  sheet   reaches  three 
minutes,   we  may.   in  addition  to  the   Schott  exercises,  order  gentle, 
general  massage,  and  as  soon  as  the  patient  can  possibly  stand  the 
treatment   the   carbon   dioxide  baths.      These  cases    frequently   suffer 
from  insomnia,  and   for  this  the  hot  and  cold  spinal  sponge  or  the 
Chapman's  ice-bag  to  the  spine  for  one  hour  may  be  instituted.    Where 
there  is  kidney  disease  we  should  limit  the  amount  of  water-drinking 
to  one  or  three  pints  daily ;  apply  the  ice-bag  over  the  heart  and  lower 
third  of  the  sternum  and  the  fomentation  to  the  kidney.     In  the  third 
stage  complete  rest  should  be  enjoined,  the  dropsy  treated  and  com- 
plications met  as  they  arise. 

Cardiac  Dilatation. 

This  is  an  increase  in  the  size  of  the  heart,  due  to  enlargement  of 
one  or  more  of  its  cavities.  It  is  a  failing  heart,  lacking  in  power 
and  compensation,  tending  progressively  to  increase  unless  the  cause 
is  removed,  and  this  fact  should  never  be  forgotten.  Dyspnea,  palpi- 
tation, "sinking,"  precordial  discomfort,  cyanosis  and  disturbances 
of  the  digestive  and  nervous  systems  usually  mark  its  course.     The 


328  PRACTICAL  HYDROTHERAPY. 

pulse  is  frequent,  irregular,  of  poor  force,  and  its  volume  illy  sus- 
tained. Its  area  upon  percussion  is  increased,  its  apex  impulse  dimin- 
ished. Dilatation  usually  originates  from  rheumatism,  the  acute 
infectious  diseases,  influenza,  nephritis,  etc.  In  acute  dilatation  com- 
plete rest  and  the  use  of  the  ice-bag  constitute  the  essential  treatment. 
In  this  disease  the  condition  is  most  suitably  met  by  the  use  of  the 
exercises  and  carbon  dioxide  baths,  especially  where  the  dilatation  is 
due  to  weak  muscle.  All  other  methods  that  increase  arterial  tension 
and  capillary  resistance  should  be  employed.  Final  improvement 
depends  largely  on  the  vigor,  nutrition  and  natural  resistance  of  the 
patients. 

Cardiac  Hypertrophy. 

This  is  an  increase  in  the  size  of  the  heart  due  to  increased 
thickness  of  the  heart  walls.  The  left  ventricle  is  more  often  affected 
because  of  the  systemic  work  thrown  upon  it.  There  is  usually  little 
subjective  disturbance,  though  there  is  a  strong  cardiac  impact,  in- 
crease in  area  of  percussion,  with  an  accentuated  second  sound.  It 
originates  from  increased  demands  on  the  circulation,  a  compensatory 
process,  in  nephritis,  valvular  lesions,  obstruction  to  pulmonary  cir- 
culation, long-continued  muscular  exertion  and  free  indulgence  in 
spirits.  These  cases  are  likewise  helped  by  the  carbon  dioxide  bath 
and  the  Schott  system  of  exercise.  The  incandescent  electric  light 
bath  may  be  used,  commencing  with  a  small  number  of  lights,  grad- 
ually increased ;  during  its  application  apply  the  ice-bag  to  the  pre- 
cordium.  The  after-treatment  should  be  that  of  a  very  brief  tonic 
measure.  Striimpeil  speaks  highly  of  the  value  of  the  neutral  bath 
at  90°  to  93°  F.  for  twenty  to  forty  minutes  daily,  and  the  author 
can  confirm  his  observation  in  this  respect.  Where  the  general  cir- 
culation is  much  resistant,  the  nitrites  should  be  administered  in 
small  doses. 

Fatty  Heart. 

This  embraces  two  distinct  affections,  fatty  infiltration,  in  which 
there  is  an  abnormal  accumulation  of  fat  on  or  about  the  surface  of 
the  organ  and  in  the  interstitial  tissue,  and  fatty  degeneration,  the 
transformation  of  the  cardiac  muscular  fiber  into  fat.  They  are 
usually  the  concomitants  of  general  obesity.  In  infiltration  the  mus- 
cular fiber  is  weakened,  tending  toward  dilatation.  The  obese  fre- 
quently suffer  with  slight  intermittence  of  the  pulse,  feeble  apex 
beat  and  some  enlarged  area  of  dullness.  It  is  more  common  in  those 
who  lead  a  sedentary  life  and  occupation ;  certain  races  are  predis- 
posed to  it.  Heredity,  age,  sex,  the  ingestion  of  beer,  sweets, 
starches  and  excessive  indulgence  at  the  table  are  among  the  commoner 
conditions  that  are  found.  Dilatation  of  the  heart  may  frequently 
supervene   unless   treatment   is   undertaken.      In   the   management   of 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.        329 

these  cases  we  should  follow  along  the  lines  laid  down  for  the  treat- 
ment of  obesity,  in  connection  with  the  Schott  method.  It  is  an 
excellent  idea  to  commence  with  the  Schott  system  of  baths  and 
exercises  supplemented  by  massage  and  later  place  the  patient  upon 
Oertel's  method,  which  is  especially  valuable  after  the  above  course 
of  treatment  and  which  was  really  originated  for  the  management  of 
fatty  hearts.  The  author  has  had  considerable  experience  in  the 
management  of  these  cases  and  feels  that  where  the  treatment  is  early 
taken  in  hand  relief  and  "cure"  may  be  promised.  Patients  are 
prone  as  a  rule  to  be  careless  with  their  exercise  and  diet  during  the 
time  they  are  from  under  the  supervision  of  the  physician,  and  for 
that  reason  we  should  insist  upon  their  following  out  a  rigid  "course" 
of  treatment  of  five  or  six  weeks'  time  each  year.  It  is  most  difficult 
to  convince  them  of  the  necessity  of  so  doing. 

Arterio-Sclerosis ;  Hypertension. 

Arterio-fibrosis  is  a  thickening  of  the  walls  of  the  arteries  due  to 
morbid  changes  in  the  intima,  giving  rise  to  a  localized  or  general 
narrowing  of  the  caliber  or  lumen  of  the  vessel.  Hypertension  may 
exist  independently  of  arterio-sclerosis  but  is  indicative  of  a  tendency 
toward  vascular  thickening.  In  true  arterio-sclerosis  the  vessel  wall 
is  hard,  the  heart  is  hypertrophied ;  its  second  sound  accentuated  and 
snappy ;  the  peripheral  resistance  increased.  Cardiac  dilatation  may 
follow  this  condition.  Dyspnea,  palpitation,  headache,  vertigo,  palsies, 
arcus  senilis  usually  accompany  the  disease.  It  occurs  most  frequently 
in  old  age  or  in  the  middle  aged,  although  I  have  seen  the  condition 
in  patients  under  thirty.  Heredity,  alcohol,  rheumatism,  gout,  malaria, 
syphilis,  overwork  and  overeating  tend  to  produce  the  trouble.  These 
cases  must  lead  a  quiet,  well  regulated  life,  free  from  anxieties  and 
worry,  avoid  excess  in  eating,  use  no  alcoholic  spirits  and  take  courses 
of  the  nitrites  and  nitroglycerine.     The  diet  should  be  simple. 

Dietary  change  must  not  be  too  rapidly  made,  but  its  gradual 
regulation  and  change  may  be  made  within  three  to  six  months.  No 
revolution  is  needed  but  a  common  sense  method  of  limiting  both  the 
quantity  and  quality.  These  patients  should  avoid  fluids  with  ordinary 
hearty  meals,  giving  up  soups,  especially  meat  soups,  and  confining 
the  use  of  all  fluids  to  four  or  six  ounces  at  a  meal.  In  proper  cases 
permit  fluids  between  meals.  When  digested,  milk  is  best  of  all. 
Increase  vegetables  and  diminish  meats.  Use  white  meats,  save  in 
those  of  anemic  tendencies,  when  red  meat  may  occasionally  be 
needed.  Substitute  digestible  fish  for' even  some  white  meat.  Exclude 
game,  save  fresh  white  game.  Discard  sweets  and  starchy  desserts, 
overseasoning,  spices,  and  condiments.  Contrary  to  the  general  idea, 
very  moderate  quantities  of  water  should  be  drunk ;  this  tends  to  in- 
crease the  tension  and  do  damage  to  the  already  overworked  kidney 


330  PRACTICAL  HYDROTHERAPY. 

(see  Chronic  Nephritis)  unless  severe  toxemia  is  present.  Trinecek 
has  advocated  the  moderate  use  of  water  so  "mineralized"  as  to  re- 
semble the  plasma,  containing  as  it  does  certain  inorganic  salts.  Each 
250  c.c.  of  water  is  to  contain  sodium  sulphate  0.008,  sodium  chloride 
0.1,  sodium  phosphate  0.003,  sodium  carbonate  0.005,  potassium 
sulphate  0.008. 

In  the  very  early  stages  of  the  disease  and  in  those  who  are 
vigorous  we  may  commence  the  cautious  use  of  hydrotherapy  by 
administering  the  full  dry  pack  followed  by  a  rapid  cold  sponge,  care 
being  taken  to  keep  the  head  cool.  As  soon  as  we  have  tested  the 
reaction  of  the  patient  we  may  administer  the  electric  light  bath  until 
perspiration  takes  place  followed  by  the  horizontal  rain  bath  at  100° 
to  105°  F.  for  one  and  one-half  minutes  reduced  at  first  to  80°  F. 
for  one- fourth  minute;  pressure  twenty  pounds.  Cautiously  reduce 
the  temperature  one  degree  daily,  studying  the  reactive  capacity  of 
the  patient.  Huchard3  says  that  he  has  found  the  low-pressure  neutral 
jet  douche  at  92°  to  96°  F.,  applied  to  either  side  of  the  spinal  column 
for  three  to  eight  minutes,  a  powerful  nerve  sedative  and  circulatory 
help.  He  gradually  passes  to  the  neutral  horizontal  rain  or  circular 
needle  bath  for  one  to  two  minutes,  gradually  reduced  to  the  point 
of  pleasant  coolness,  this  to  be  regulated  by  the  patient.  I  can  un- 
questionably substantiate  his  experience  and  statement  that  "heart 
disease  and  other  pathologic  conditions  of  heart  weakness  are  very 
often  dependent  not  only  upon  the  heart  itself  and  its  innervation,  but 
also  upon  peripheral  innervation,  and  that  when  sedation  occurs  the 
general  disturbance  improves  or  ceases.''  Hirschfeld  believes  that 
where  they  can  be  borne  the  hot  full  bath  is  an  excellent  home  method ; 
the  skin  becomes  vascular,  relieves  the  internal  organs,  lifts  the  load, 
relieves  insomnia,  increases  metabolism  and  oxidation,  eliminates 
waste  materials  and  increases  the  vascular  "habit"  of  the  cutis.  In 
most  cases  it  is  best  to  commence  with  the  carbon  dioxide  bath,  grad- 
ually increasing  its  strength  as  the  patient  responds.  This  method  is 
especially  valuable  where  we  have  a  concomitant  cardiac  dilatation, 
as  it  strengthens  the  heart  muscle. 

Regarding  the  use  of  baths  and  gymnastics  in  arterio-sclerosis, 
J.  Groedel,  of  Bad-Xauheim,  who  has  given  special  attention  to  the 
treatment  of  arterio-sclerosis,  contends  that,  although  the  increased 
blood-pressure,  "considered  as  the  usual  consequence  of  treatment  by 
the  Xauheim  baths,  may,  at  first  sight,  seem  to  indicate  that  every 
patient  with  arterio-sclerosis  should  be  excluded  from  a  treatment  by 
baths,  a  further  increase  of  the  high  blood-pressure  usually  found  in 
arterio-scleorsis  must  not  only  surcharge  the  heart  more  than  is  already 
the  case,  but  also  create  the  danger  of  the  bursting  of  a  cerebral 
aneurism,  so  often  present  in  cases  of  arterio-sclerosis."     He  has  by 

3  Huchard,   M. :   Blatter  f.   klinische  Hydrotherapie,   1904. 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.        331 

numerous  observations  been  able  to  convince  himself  that  baths  can 
lie  prescribed  for  these  patients  "in  such  a  manner  that  the  increase 
of  blood-pressure  d<  es  not  take  place,  or  only  in  a  very  slight  degree." 
If  the  temperature  be  kept  almost  at  the  point  of  "indifference" — 

that  is,  about  92  to  93  F.  i  33.2  to  33.8°  C. )— the  primary  acute 
increase  of  blood-pressure  caused  by  the  contraction  of  the  cutaneous 
Is,  and  most  to  be  feared,  will  be  very  slight,  and  if  there  be 
carbonic  acid  in  the  bath  it  will  at  the  same  time  quickly  disappear. 
If  the  skin  of  the  patient  be  cooled  somewhat  by  moistening  the  parts 
particularly  sensitive  to  cold  before  entering  the  bath,  the  avoidance 
of  that  primary  increase  of  blood-pressure,  or,  indeed,  any  shock 
whatever,  will  be  the  more  certain.  A  similarly  good  effect  is  pro- 
duced when  the  patient  is  only  allowed  to  take  half  baths  and  the 
of  the  body  are  wrapped  up  so  as  to  prevent  cooling. 
In  most  cases  the  amount  of  water  can  be  increased  little  by  little  at 
each  bath  until  a  full  bath  is  at  length  attained,  but  even  then  it  is 
advisable  to  let  the  patient  only  submerge  his  body  by  degrees. 
Placing  cold  bandages  on  the  bather's  head  is  often  indicated.  By 
proceeding  cautiously  in  this  manner  he  has  never  had  an  unfortunate 
case  in  the  course  of  a  practice  of  twenty-two  years  in  Xauheim. 
Under  what  conditions  is  a  course  of  baths  indicated  or  beneficial  in 
cases  of  arterio-sclerosis?  It  is  mostly  a  question  of  diseases  based 
on  the  same  etiological  principle  as  arterio-sclerosis  itself,  or  such  as 
usually  lead  to  it.  By  combating  these  we  can  at  the  same  time  retard 
the  progress  of  the  sclerotic  process  in  the  vessels. 

Angina  Pectoris. 

Angina  pectoris  is  dependent  upon  organic  disease  of  the  heart 
or  aorta.  It  is  of  sudden  onset,  with  agonizing  pain  in  the  sternal 
region,  a  sense  of  constriction  and  impending  death.  The  pain 
radiates  to  .the  back,  shoulders  and  arm,  especially  the  left.  During 
the  attack  the  patient  is  pale,  motionless,  haggard ;  the  cold  sweat 
stands  upon  the  brow ;  sits  or  stands  immobile.  The  attack  may 
prove  suddenly  fatal  or  occur  at  irregular  intervals.  It  is  frequently 
found  associated  with  other  diseases — arterio-sclerosis,  cardiac  hyper- 
trophy or  dilatation,  aortic  regurgitation  and  feebleness  of  muscular 
power.  It  occurs  usually  after  forty  years  of  age,  and  is  most  fre- 
quent in  males.  Causative  factors  to  be  looked  for  are  alcohol, 
syphilis,  rheumatism,  gout,  diabetes,  nephritis  and  la  grippe.  The 
attacks  are  often  precipitated  by  over-exertion,  worry  and  digestive 
disorders.  There  is  usually  sclerosis  of  the  coronary  arteries. 
Da  Costa  says  that  "hardly  an  affection  of  the  walls  or  cavity  of  the 
heart,  scarcely  a  morbid  condition  of  the  arteries  that  nourish  it  or 
spring  from  it.  with  which  the  distressing  malady  has  not  been  ob- 
served  to  be   associated/'       In  most  cases   we  find  a  large  neural 


332  PRACTICAL  HYDROTHERAPY. 

element,  toxic  irritation,  high  tension  or  arterio-sclerosis.  Schott 
believes  it  to  be  due  to  a  further  reduction  of  the  muscular  energy 
of  an  already  enfeebled  heart  muscle,  accompanied  by  pathologic 
sclerosis  of  the  coronary  vessels,  plus  the  resistance  01  a  contracted 
arterial  system.  It  is  a  dangerous  malady,  but  life  may  be  prolonged 
for  years.  During  the  attack  nitrite  of  amyl  or  nitroglycerine  should 
be  immediately  administered,  the  patient  placed  in  a  recumbent 
position,  friction  applied  to  the  limbs,  and  if  the  heart  is  beating 
weakly  an  ice-bag  over  the  precordium.  In  the  general  management 
of  the  case  we  should  forbid  all  stimulants,  tobacco  and  coffee.  The 
life  should  be  regular  and  free  from  worry,  the  diet  simple,  the  fluids 
restricted.  The  presence  of  arterio-sclerosis  must  be  constantly  borne 
in  mind  and  proper  treatment  instituted.  In  these  cases  the  full 
method  of  the  carbon  dioxide  bath  and  the  Schott  system  of  exercise 
should  be  instituted,  carefully  graduated  to  suit  the  individual  case, 
but  most  persistently  and  systematically  followed  out.  The  course 
of  treatment  is  to  be  given  for  some  months,  depending  on  the  case; 
time  is  allowed  to  intervene  and  another  course  instituted.  These 
patients  purchase  existence,  and  even  life  itself,  only  by  the  care  and 
attention  with  which  they  follow  out  instructions  and  take  their 
courses  of  treatment.  During  the  non-treatment  interim  the  patient 
should  take  small  doses  of  some  nitrite  and  use  the  Chapman's  ice- 
bag  applied  over  the  fourth  dorsal  to  the  third  lumbar  spinal  segment 
once  or  twice  daily  for  forty  minutes.  The  writer  has  seen  some 
good,  he  believes,  come  from  the  application  of  the  galvanic  current 
to  the  vagus  in  the  neck  and  from  the  use  of  the  static  wave 
current.  Some  cases  seem  to  do  best  upon  nitrite  of  soda,  two  to 
five  grains  four  times  daily ;  others  better  upon  erythroltetranitrate, 
grains  one,  three  to  four  times  daily. 

Functional  Heart  Disease;  Cardiac  Neuroses;  Cardiac  Collapse; 

Neurasthenic  or  Weak  Heart;  Palpitation;  Brachycardia; 

Tachycardia;  Arhythmia. 

The  functional  disorders  of  the  heart  are  grouped  together,  as 
the  general  treatment  of  these  conditions  is  similar  and  the  author 
does  not  care  to  repeat  needlessly  treatment  for  separate  states  where 
they  can  be  grouped.  Certain  forms  of  them  require  a  few  special 
applications,  and  these  will  be  duly  noted. 

Palpitation  is  an  undue  and  rapid  heart  action,  the  frequency  of 
the  beats  being  sufficient  to  cause  discomfort,  usually  accompanied 
by  more  or  less  irregularity  of  rhythm.  The  heart  becomes  tumultu- 
ous. There  is  a  sensation  of  precordial  discomfort,  violent  beat 
against  chest,  face  pale.  It  most  frequently  occurs  from  some  sudden 
scare,  nervous  strain  or  excitement,  and  usually  disappears  after  the 
cause  is  removed.     It  is  more  frequent  in  females  than  in  males.     It 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.       333 

is  also  caused  by  anxieties,  business  responsibilities  and  worries,  fear, 
emotion,  anemia,  digestive  disorders,  neurasthenia,  excessive  tobacco, 
etc.  Physical  examination  shows  a  negative  cardiac  condition,  and 
for  that  reason  care  should  be  taken  to  seek  for  the  causal  factors 
underlying  the  trouble  and  remove  them. 

Tachycardia  /'s  an  abnormal  rapid  heart  whose  action  is  regular, 
unattended  by  other  symptoms;  perfect  general  and  cardiac  health 
may  exist  with  this  disorder  present.  We  may  have  paroxysmal 
attacks  due  to  fright  and  emotion,  the  pulse  being  so  rapid,  thin  and 
compressible  as  to  be  uncountable.  Care  should  be  taken,  however, 
to  carefully  seek  for  factors  that  produce  tachycardia,  especially  the 
forms  of  exopthalmic  goiter.  The  condition  is  probably  due,  as 
Woods  says,  to  a  lesion  of  the  accelerator  of  the  heart.  Where 
exopthalmic  goiter  exists  this  disease  should  be  treated,  as  the  cardiac 
condition  forms  but  a  part  of  the  symptom-complex.  In  all  cases 
the  digestive  condition  should  be  investigated,  and  if  necessary  lavage 
practiced  and  intragastric  faradization  used.  In  these  diseases  the 
ice-bag  over  the  precordium  is  especially  valuable,  as  it  diminishes 
the  number  of  cardiac  pulsations,  increases  the  systolic  force  by 
acting  directly  on  the  myocardium,  increases  blood  pressure  and 
respiration. 

Neurasthenia,  or  zveak  feeble  heart,  demands  no  special  treatment 
other  than  that  embraced  in  the  treatment  of  neurasthenia  itself,  to 
which  section  the  reader  is  referred. 

Arhythmia  is  a  condition  accompanied  by  cardiac  irregularity  both 
as  to  the  time  and  power  of  the  heart  beat.  The  heart  may  intermit 
and  miss  a  beat,  a  feeling  that  is  very  disagreeable  to  most  cases. 
Many  forms  of  the  trouble  exist— Trawles'  pulsus  alternans,  in  which 
one  pulse  is  normal,  the  next  feeble;  Kussmaul's  pulsus  paradoxus, 
in  which  the  heart  beats  more  frequently,  but  weaker  during  the 
inspiration  than  expiration,  this  condition  having  been  most  frequently 
observed  in  pericarditis ;  pulsus  bigeminus,  or  the  double  pulse — that 
is  to  say,  a  pulse  in  which  we  have  two  successive  rapid  beats,  then 
two  successive  slower  beats,  most  frequently  found  in  mitral  disease; 
delirium  cordis,  in  which  all  these  conditions  may  be  present.  These 
variations  from  the  normal  may  exist  in  apparently  well  individuals, 
but,  generally  speaking,  some  disease  is  more  or  less  present.  Im- 
mediate relief  and  comfort  may  be  secured  by  the  application  of  the 
ice-bag  to  the  precordium. 

Brachycardia,  or  slow  pulse,  may  give  rise  to  no  symptoms,  al- 
though vertigo,  tinnitus  or  headache  may  accompany  the  disease. 
It  sometimes  follows  acute  fevers,  chronic  dyspepsia,  nephritis, 
apoplexy,  cerebral  tumors,  general  paresis,  melancholia,  sun  stroke, 
etc.  It  is  a  rare  disease  in  the  author's  experience.  During  the 
sudden  attacks  the  recumbent  position  should  be  immediately  sought 


334  PRACTICAL  HYDROTHERAPY. 

and  a  small  dose  of  brandy  or  whisky  given,  diluted  with  very  hot 
water.  The  underlying  causal  conditions  must  be  especially  treated 
in  this  disease. 

Cardiac  collapse  or  shock  occurs  most  frequently  after  surgical 
operations,  great  strains  or  anything  that  tends  to  suddenly  upset 
the  nervous  system.  It  may  be  again  stated  that  the  skin  of  the 
precordium  is  in  special  reflex  relation  to  the  heart,  and  that  many 
patients  could  be  saved  by  means  of  hydrotherapy  alone  without 
recourse  to  the  hypodermic  syringe  were  proper  measures  adopted. 
The  proverbial  ounce  of  prevention  is,  of  course,  worth  more  than 
the  pound  of  cure,  but  where  collapse  is  threatened  or  has  occurred 
the  ice-bag  should  be  immediately  applied  over  the  heart ;  at  the  end 
of  fifteen  minutes  removed  and  a  very  hot  fomentation  (140°  F.) 
applied  for  one  or  possibly  two  minutes,  followed  again  by  the  ice- 
bag.  If  possible  the  patient  should  drink  hot  water  and  the  hot 
enema  be  given  at  once.  Every  care  and  precaution  must  be  taken 
to  prevent  chilling,  and  the  best  method  is  the  enveloping  of  the 
patient  in  the  full  dry  pack  covered  with  several  additional  blankets. 
During  the  period  that  the  patient  is  in  the  pack  general  stimulation 
of  the  nervous  cardiac  force  may  be  brought  out  by  short  very  cold 
applications  of  water  to  the  face  and  nape  of  the  neck.  Very  hot 
applications  to  the  spine  frequently  have  a  rousing  and  stimulating 
effect.  After  the  danger  has  passed  general  tonic  measures  should 
be  adopted. 

The  general  treatment  of  functional  cardiac  disorder  should  first 
embrace  the  relief  of  the  patient's  anxiety.  These  people,  as  a  rule, 
are  neurotic,  excitable,  living  in  constant  and  ever-present  fear  of 
sudden  ana  impending  death,  the  basis  of  which  is  the  uncomfortable 
feelings  associated  with  the  heart.  A  general  and  nutritious  diet 
should  be  instituted  and  care  taken  to  eliminate  all  digestive  dis- 
orders. Tea,  coffee,  liquor,  tobacco  and  other  stimulants  must  be 
forbidden.  The  most  satisfactory  method  for  securing  permanent 
relief  after  the  causal  conditions  have  been  met  has,  in  the  author's 
hands,  been  tonic  hydriatic  measures.  Commence  very  gently  by 
applying  the  full  dry  pack  for  twenty  minutes,  followed  by  the  cold 
sponge  rapidly  performed,  the  patient  being  given  a  general  friction 
with  a  coarse  towel  as  a  finishing  treatment.  After  we  have  gained 
their  confidence  we  may  use  the  electric  light  bath  or  hot-air  bath 
until  commencing  perspiration,  followed  by  the  dripping  sheet  at 
80°  F.  for  three  minutes,  with  vigorous  friction,  daily  reduced  one 
degree  until  70°  F.  is  reached,  at  which  point  we  may  substitute  the 
circular  or  horizontal  rain  bath  at  100°  to  104°  F.  for  one  and  one-half 
minutes,  reduced  to  70°  F.  for  one-fourth  minute,  under  a  pressure  of 
twenty  pounds,  reducing  the  pressure  one  degree  daily  to  60°  F.  and 
increasing  the  pressure  gradually  to  thirty  pounds.     Where  there  is 


DISEASES  OF  HEART  AND  BLOOD-VESSELS.       335 

any  discomfort  during  the  administration  of  this  bath  from  oppression 
or  shortness  of  breath,  we  should  instruct  patients  to  open  the  mouth 
wide  and  breathe  deeply,  or  apply  an  ice-bag  over  the  heart  during  the 
application  of  the  first  hath  or  two.  As  soon  as  we  have  trained  the 
individual  to  stand  the  above  measures  we  should  use  the  following: 
Electric  light  bath  until  free  perspiration  takes  place,  followed  by 
the  circular  or  horizontal  rain  bath  at  100°  to  104°  F.  for  one  and 
one-half  minutes,  this  to  be  followed  in  its  turn  by  the  fan  douche 
to  the  entire  body  for  one-fourth  minute  and  the  jet  douche  to  the 
spine  and  lower  limbs  for  one-fourth  minute  at  60°  F.,  under  twenty 
to  twenty-five  pounds'  pressure.  It  is  really  marvelous  to  see  the 
changes  that  will  take  place  in  these  individuals  under  this  course  of 
treatment.  The  pulse  becomes  normal,  the  arteries  full,  the  neural 
element  removed,  the  digestion  and  elimination  improved,  the  skin 
pliable  and  rosy,  and  the  patient  begets  an  independence  and  con- 
fidence to  which  he  has  heretofore  been  a  total  stranger.  In  many 
cases  it  is  advisable  at  the  same  time  to  administer  digestants,  hema- 
tinics  and  strychnia. 


CHAPTER  XVII. 

DISEASES     OF     THE     PERIPHERAL     NERVES,     BRAIN     AND 

SPINAL     CORD. 

Neuritis;     Facial  Palsy. 

Neuritis  is  an  inflammation  of  the  peripheral  nerve  trunks,  asso- 
ciated with  more  or  less  degenerative  changes  in  the  nerves,  and 
characterized  by  pam,  impaired  sensation,  motor  paralysis,  atrophy 
and  the  reaction  of  degeneration.  It  most  often  originates  from 
injury,  compression,  rheumatism,  alcohol  intoxications,  infectious 
disease,  gout,  diabetes,  etc.  The  outcome  is  generally  favorable 
where  the  patient  receives  prompt  and  proper  treatment.  During 
the  acute  stage  the  patient  should  be  put  to  bed,  or,  if  it  is  that  of 
a  single  nerve,  the  part  put  at  absolute  local  rest.  This  is  oftentimes 
best  secured  by  means  of  a  padded  splint.  Calomel,  followed  by  a 
saline,  should  be  immediately  administered  and  the  diet  restricted 
to  liquids  or  semi-solids.  Search  for  any  causal  influences  that  are 
producing  the  trouble  and  treat  the  general  condition. 

It  is  the  writer's  invariable  plan  to  divide  the  treatment  of  simple 
neuritis  into  that  of  general  and  local.  The  patient  is  placed  upon 
a  general  ehminative  treatment,  consisting  of  either  the  electric  light 
bath  or  the  superheated  dry  hot  air,  administered  until  profuse  per- 
spiration takes  place.  The  author's  preference  is  decidedly  for  the 
superheated  dry  hot  air,  followed  by  the  use  of  the  rain  bath  at 
104°  F.  for  one  and  one-half  to  two  minutes,  reduced  to  80°  F.  for 
one-half  minute,  twenty  pounds  pressure,  reducing  temperature  one 
degree  to  65°  F.  and  increasing  pressure  one  pound  until  thirty  is 
registered.  This  treatment  is  given  once  daily,  and  during  the  interim 
the  fomentation  is  applied  to  the  affected  parts  at  least  once  every 
two  hours,  and  in  addition  once  daily  a  stabile  galvanic  treatment  is 
given.  The  author  is  satisfied,  from  no  small  experience,  that  this 
treatment  has  saved  many  cases  long  periods  of  treatment  during 
the  chronic  stage,  and  has  in  cases  of  facial  palsy  been  unusually 
effective.  Where  access  cannot  be  had  to  the  above  general  measures, 
we  may  employ  the  full  wet  pack  at  80°  F.  for  one  hour,  reducing 
the  temperature  two  degrees  daily  until  60°  F.  is  reached,  and  em- 
ploying the  fomentation  and  galvanic  treatment  as  above  outlined. 
The  author  has  seen  some  good  results,  he  believes,  from  the  admin- 
istration with  this  treatment  of  the  salicylates. 
(336) 


NERVES,  BRAIN  AND  SPINAL  CORD.  337 

In  the  chronic  stage  of  neuritis  we  have  to  deal  with  the  various 
paralytic  trophic  and  other  symptoms  left  over  from  the  acute  attack. 
We  may  continue  the  use  of  the  electric  light  hath  or  superheated 
dry  hot  a.r  hath  until  profuse  perspiration  take-  place,  followed  hy 
the  rain  bath  at  104°  F.  for  one  and  one-half  minutes,  pressure 
thirty  pounds,  this  in  turn  being  followed  by  the  fan  douche  to  the 
body  at  60°  F.  for  one-half  minute,  pressure  twenty  pounds.  As  a 
finishing  treatment,  the  Scottish  fan  douche  to  the  affected  parts, 
ranging  from  110°  to  115°  F.  for  one-third  to  one-half  minute  to 
60°  F.  for  ten  seconds,  will  he  found  a  most  valuable  aid.  During 
this  stage  we  must  continue  to  treat  causal  indications,  realizing  that 
they  are  the  underlying  factors  of  the  disease,  and  unless  removed 
are'  likely  to  prolong  the  treatment.  In  the  chronic  stage,  where 
access  cannot  be  had  to  institutional  treatment,  we  may  employ  the 
full  wet  pack  at  60°  F.  for  one  hour  once  daily.  In  connection  with 
above  outlined  treatment,  the  writer  has  found  general  and  local 
massage,  vibration  and  the  galvanic  current,  applied  to  the  paralyzed 
parts  in  sufficient  strength  to  produce  gentle  contractions,  a  most 
table  method  or  combination  of  treatment.  Every  endeavor  should 
be  made  to  avoid  the  use  of  morphine. 

Sciatic  Neuritis— Sciatica. 

This  form  of  neuritis  and  neuralgia  is  so  frequent,  so  persistent 
and  difficult  of  handling  that  the  author  feels  it  deserves  special  con- 
sideration., in  view  of  the  fact  that  the  treatment  herein  outlined  has 
proved,  in  his  hands,  almost  a  specific  in  the  management  of  the 
disease.  The  sciatic  plexus  is  made  up  from  the  lumbo-sacral  cord 
by  the  anterior  division  of  the  three  sacral  nerves  and  part  of  the 
fourth.  The  sciatic  nerve  is  in  reality  a  continuation  of  the  sacral 
plexus,  and  leaves  the  pelvis  by  passing  through  the  great  sacro- 
sciatic  foramen,  below  the  pyriformis  muscle,  and  passing  through 
the  buttock  between  the  tuberosity  of  the  ischium  and  the  great 
trochanter,  it  terminates  at  the  popliteal  space  by  breaking  up  into  the 
external  and  internal  popliteal  branches,  and  finally  ending  in  the 
tibial  and  cutaneous  branches.  It  supplies  the  muscles  of  the  back 
of  the  thigh,  those  of  the  leg  and  foot  and  nearly  the  whole  integu- 
ment of  the  leg.  It  is  made  up  of  motor,  sensory,  reflex,  trophic  and 
muscular  sense  fibers.  It  is  the  largest  nerve  in  the  body,  and  is  most 
often  diseased.  The  conditions  that  influence  sciatic  neuritis  are 
those  that  cause  neuritis  of  other  nerves,  although  season  has  a  more 
intimate  relation  to  this  disease  than  other  forms  of  neuritis.  The 
pathologic  anatomy  is  that  of  a  peri-interstitial  neuritis  affecting  the 
adventitia.  The  nerve  is  usually  edematous  and  swollen,  and  as  a 
result  of  this  condition  pressure  and  irritation  develop,  affecting  the 
nerve  fibers   secondarily.     Inflammation  may  extend   into  the  nerve 


338  PRACTICAL  HYDROTHERAPY. 

substance  and  fibers,  in  which  case  we  may  have  true  degenerative 
conditions.  These  manifestations  are  usually  worse  and  more  notice- 
able in  that  part  of  the  nerve  that  is  close  to  the  sciatic  notch. 

Sciatic  neuritis  is  one  of  the  most  painful  and  trying  diseases  of 
the  nerves  to  which  one  may  be  subjected,  the  pain  being  intense, 
lancinating,  boring  and  burning  in  character,  much  worse  at  night, 
with  intense  paroxysms  which  may  be  brought  on  from  cold,  move- 
ment, manipulation  or  other  trivial  causes.  In  the  acute  stage  our 
aim  should  be  to  at  once  bring  the  patient  under  the  general  influence 
of  constitutional  treatment,  besides  adopting  such  local  measures  as 
will  relieve  pain,  produce  comfort  and  induce  sleep.  The  author 
usually  starts  the  treatment  with  the  administration  of  a  brisk  mer- 
curial, following  this  with  a  saline,  and  during  the  attack  administers 
the  salicylates  or  alkalies,  avoiding  as  far  as  possible  the  adminis- 
tration of  morphine  and  never  using  whisky.  Care  must  be  exercised 
in  the  handling  of  the  leg  in  the  acute  stage,  as  well  as  the  adoption 
of  a  very  stimulating  treatment.  The  treatment  of  the  acute  and 
chronic  stages  varies  only  in  degree  rather  than  method,  and  we  will 
therefore  consider  the  treatment  of  a  chronic  case  of  sciatic  neuritis 
rather  than  separate  the  two.  The  diet  should  be  plain,  with  no  meat, 
and  as  far  as  possible  purin-free.  In  the  acute  stage  it  should  be 
liquid  absolutely.  Large  volumes  of  water  must  be  drunk  unless  we 
have  an  associated  arterio-sclerosis  or  cirrhotic  kidney  to  deal  with. 
During  the  acute  stage  rest  is  useful,  and  treatment  is  best  adminis- 
tered in  bed.  Of  all  the  methods  of  reaching  sciatic  neuritis  or  sci- 
atica, hydrotherapy  is  the  most  satisfactory,  and  without  mentioning 
other  forms  of  treatment  the  writer  will  at  once  detail  the  method 
that  has  in  his  hands  proved  so  satisfactory. 

The  patient  is  placed  in  the  superheated  dry  hot  air  body  appa- 
ratus, carefully  enveloped  in  Turkish  toweling,  at  a  temperature  of 
from  250°  to  350°  F.,  care  being  taken  to  apply  a  cold  compress  to 
the  head,  or,  what  is  better,  the  ice-helmet.  The  patient  remains  in 
the  apparatus  from  one-half  to  one  hour,  during  which  time  he  per- 
spires very  freely.  At  the  end  of  this  time  he  is  removed  to  the  full 
dry  pack  so  arranged  as  to  permit  the  folds  of  the  blanket  to  be  open 
for  ready  access  to  the  sciatic  nerve.  Very  hot  fomentations  at  a 
temperature  of  140°  to  160°  F.  are  now  applied  and  allowed  to  re- 
main on  from  one  to  two  minutes,  these  being  kept  up  until  seven 
or  eight  have  been  put  on.  The  patient  is  then  placed  in  a  circular  or 
horizontal  rain  bath  at  a  temperature  of  80°  F.  for  one-half  minute. 
Note  should  be  taken  that  in  this  application  no  hot  water  is  applied 
while  in  the  circular  rain  bath.  The  patient  is  required  to  rest  one 
hour  after  the  treatment.  Where  the  patient  is  bedridden  and  un- 
able to  be  placed  in  the  superheated  dry  hot  air  apparatus,  we  may 
apply  the  full  dry  pack  and  very  hot  fomentation  as  above  described, 


D  SPINAL  CORD.  339 

followed  by  a  rapid  general  cold  sponge  and  the  application  of  a  com- 
press to  the  nerve  itself.     As  -<>on  as  able,  the  superheated  dry  hot 

air  should  be  administered.  Patient-,  as  a  rule,  progress  rapidly 
under  these  measures,  and  as  soon  as  the  intense  tenderness  has  sub- 
sided the  Scottish  jet  douche  should  be  applied,  the  temperatures 
ranging  from  120°  F.  for  thirty  seconds  to  60°  F.  for  ten  seconds, 
with  four  to  six  alternations,  the  application  being  made  up  and  down 
the  spine  and  the  back  of  the  leg.  The  finishing  treatment  should 
still  consist  of  the  circular  or  horizontal  rain  bath  at  80°  for  one-half 
minute.  Many  springs,  mud  baths  and  other  treatments  have  been 
suggested  for  this  disease,  and,  judging  from  the  cases  that  have 
failed  to  secure  relief  by  these  measures,  the  writer  is  forced  to  the 
conclusion  that  the  baths  at  the  springs  either  possess  little  or  no 
value  or  are  administered  by  persons  who  are  not  thoroughly  versed 
in  hydriatic  procedures.  As  associated  measures,  general  massage 
and  the  local  application  of  the  high-tension  faradic  from  a  very  fine 
wire  i  32  to  36)  coil,  in  combination  with  the  galvanic  current,  will 
add  to  the  sedative,  stimulating  and  reconstructive  powers  of  water. 
The  static  current  possesses  some  value,  and  the  author  oftentimes 
uses  these  three  in  a  detailed  schedule  of  treatment.  Drugs  possess 
little  value  in  the  specific  treatment  of  the  disease,  but  the  functional 
condition  of  the  stomach  and  intestinal  tract  should  be  given  atten- 
tion in  this  direction. 

Multiple  Neuritis. 

Polyneuritis  is  a  parenchymatous  inflammation  affecting  many 
peripheral  nerves  at  once,  but  principally  those  of  the  extensors  of 
the  extremities.  It  may  originate  from  bacterial  infection,  from 
toxic  substances  circulating  in  the  blood,  such  as  alcohol;  from 
dyscrasic  states,  such  as  gout  and  rheumatism,  or  from  anemia  and 
malnutrition.  It  is  a  serious  disease,  and  unless  promptly  and 
properly  treated  its  mortality  is  fairly  high.  It  is  usually  accom- 
panied by  pain,  paralysis  with  wrist  and  foot  drop,  less  of  the  re- 
flexes, sensory  disturbances,  trophic  changes,  reaction  of  degenera- 
tion, mental  forgetfulness,  and  sometimes  falsification  of  memory. 
In  the  acute  stages  our  aim  should  be  at  once  to  remove  all  for- 
eign or  toxic  substances  from  the  system,  and  for  that  reason  alco- 
hol and  tobacco  are  immediately  withdrawn,  especially  in  view  of 
the  fact  that  to  attempt  to  "taper  off"  will  be  productive  of  harm 
rather  than  good.  A  purgative  consisting  of  calomel  and  aloin,  fol- 
lowed by  a  saline,  must  be  immediately  administered,  the  patient  put 
to  bed  and  at  absolute  rest.  The  question  of  rest  is  an  exceedingly 
important  one  in  this  disease,  and  during  the  early  stage-  it  must  be 
secured  if  we  hope  to  preserve  the  patient  and  hasten  recovery.  The 
diet  should  be   liquid,   consist  of  milk,   eggs,   cereals   and    fruits;  no 


340  PRACTICAL  HYDROTHERAPY. 

tea,  coffee,  cocoa  or  meats  are  to  be  allowed.  During  this  stage  the 
applications  should  all  be  hot.  Once  daily  the  patient  is  given  the 
hot  full  pack  for  thirty  minutes,  after  which  he  is  to  be  rapidly  dried, 
wrapped  in  blankets  and  kept  warm  for  at  least  an  hour  before  resum- 
ing the  ordinary  night  dress.  The  most  satisfactory  application  is 
the  hot  full  bath  at  100°  to  110°  F.  for  ten  to  fifteen  minutes,  although 
great  care  must  be  exercised  in  lifting  the  patient  into  the  tub,  best 
accomplished  by  means  of  a  sheet,  the  lifting  being  done  from  either 
end.  During  the  interim  we  may  apply  either  hot  circular  compresses 
to  the  limbs  affected,  or  dry  heat  to  the  extremities  and  over  the  ab- 
domen. Where  the  pain  is  especially  severe,  in  addition  to  the  hot 
applications  to  the  extremities,  employ  the  fomentation  at  130°  to 
140°  F.  to  the  spine,  much  relief  in  this  way  being  frequently  ob- 
tained. Where  there  is  threatened  cardiac  failure,  apply  the  ice-bag 
to  the  precordium  for  fifteen  to  twenty  minutes  four  or  five  times 
daily.  After  the  subsidence  of  the  acute  stage  tonic  measures  may 
be  instituted,  of  which  the  author  has  found  the  general  wet  pack 
for  one  hour  at  80°  F.,  reduced  one  degree  daily  to  65°  F.,  a  service- 
able method.  As  soon  as  the  patient  is  up  and  able  to  get  about  we 
should  commence  the  administration  of  the  electric  light  bath  or 
hot-air  bath  until  perspiration  takes  place,  followed  by  the  rain  bath 
at  100°  to  104°  F.  for  two  minutes,  reduced  to  65°  for  one-fourth 
minute.  As  associated  measures  use  general  massage,  vibration  and 
electricity ;  contract  the  muscles  mildly,  not  too  vigorously.  These 
patients  will  oftentimes  be  found  to  be  semi-ataxic,  and  in  their  case 
we  may  employ  with  benefit  the  re-education  movements  or  exercises 
of  Fraenkel,  detailed  in  another  section.  Strychnia,  per  oram  or  hypo- 
dermatically,  often  proves  of  service. 

Neuralgia;  Intercostal  Neuralgia;  Tic  Douloureux. 

Neuralgia  is  a  condition  characterized  by  pain  in  the  course  of 
a  nerve  or  nerves.  The  pain  may  be  nearly  continuous  or  parox- 
ysmal, and  sharp,  boring,  stabbing  or  darting  in  character.  Tender 
points  are  found  at  the  exit  of  nerves  from  bony  channels  or  fascia 
of  muscles.  Hallucinatory  neuralgia  frequently  occurs  in  those  who 
are  addicted  to  the  morphine  habit.  Care  should  be  taken  to  distinguish 
between  neuralgia  and  neuritis.  Neuralgias  are  anatomically  divided 
into  trigeminal,  cervico-occipital,  brachial,  intercostal,  lumbar,  crural, 
sciatic  and  visceral.  Sciatica  has  already  been  considered.  Tic  dou- 
loureux is  a  form  of  neuralgia  due  to  an  obliterating  arteritis  that 
usually  accompanies  arterio-sclerosis.  Neuralgias  may  originate  spon- 
taneously— that  is  to  say,  idiopathic;  may  arise  from  toxic  causes,  be 
reflex,  hemic  or  organic.  It  is  a  disease  of  adult  life,  women  being 
more  frequently  affected  than  men,  heredity  often  playing  an  impor- 
tant part.      The   rheumatic,   gouty,   anemic,   and  those   whose  consti- 


RVES,  BRAIN  AND  SPINAL  CORD.  341 

tutions   are   generally   broken   down,   become    favorable   subjects    for 
the  disease.     It  is  frequently  associated  with  other  diseases  and 
orders,   especially   those   of   menstruation,   insomnia,   vertigo,   neur; 
thenia,  the  morphine  habit,  etc.     It  has  seemed  to  the  author  that  of 
all  causes  provocative  of  neuralgia  auto-intoxication  plays  the  most 
prominent  part.     The  toxins  are  absorbed  from  the  gastro-intestinal 
tract,  carried  to  the  nerve  centers,  and  may,  in  addition  to  being  the 
actual  cause  of  the  nerve  pain,  precipitate  fresh  attacks  in  those  who 
are  already  suffering  from  neuralgias  due  to  other  causes.     The  out- 
look is   favorable  for  recovery  in  this  disease:    a  guarded  progn 
should  be  made  as  regards  tic  douloureux,  although  under  the  plan 
of  treatment  of  Dana,1  modified  by  the  auth  [lent  results  are 

secured. 

In  the  treatment  of  various  forms  of  neuralgia  it  is  necessary  to 
first   become   thoroughly   acquainted   with   the   causal   conditions   that 
underlie  the  particular  case  in  hand,  and  search  should  1 
such  factors  as  rheumatism,  malaria,  arterio-fibrosis  syphilis.     Of 

the  general  treatment  the  author  would  insist  upon  the  most  careful 
consideration  of  the  question  of  constipation,  which  nearly  always  - 
to  be  found  in  these  cases.  In  addition,  he  believes  that  the  removal 
of  all  narcotic  and  analgesic  drugs  should  form  a  part  and  parcel  of 
the  treatment.  Causal  factors  will  demand  certain  kinds  of  medi- 
cines, and  where  the  indications  are  clear  we  may  give  them  unless 
the  patient  has  been  over-medicated,  in  which  event  all  medicines 
should  be  temporarily  withdrawn.  The  best  climate  for  neuralgics 
is  one  of  moderate  altitude,  sunny,  sheltered  from  high  cold 
winds  and  free  from  sudden  changes  in  temperature.  Many  cases 
find  California,  the  Bahamas  and  the  Riviera  satisfactory  regions,  al- 
though this  factor  is  a  negligible  part  of  the  treatment.  Hydrother- 
apy may  be  used  both  locally  and  generally.  Heat  should  be  applied 
to  the  part  affected,  either  by  means  of  the  ceil  or  local  superheated 
dry  hot-air  apparatus.  Many  patients  have  recourse  to  the  hot-water 
bag,  Japanese  fire  boxes,  etc.,  but  the  writer  has  long  since  restricted 
his  local  treatment  of  neuralgia  to  the  very  hot  fomentation,  or  the 
use  of  local  superheated  dry  hot  air  at  a  temperature  ranging  from 
250°  F.  to  400°  F.  for  a  period  of  from  one-half  to  one  hour.  The 
fomentations  may  be  applied  once  or  twice  daily.  The  general  treat- 
ment of  neuralgia  resolves  itself  into  the  treatment  of  causal  condi- 
tions and  at  the  same  time  the  restoration  of  the  general  health.  This  is 
best  met  by  commencing  with  the  incandescent  electric  light  bath, 
continuing  for  a  few  minutes  until  the  patient  becomes  thoroughly 
warm,  followed  by  the  dripping  sheet  at  a  temperature  of  80°  F.  for 
three  minutes  with  vigorous  friction.  Increase  the  light  bath  each 
day  until  the  patient  begins  to  perspire  freely,  and  decrease  the  tem- 

1   Dana,  C.   L. :   "Text-Book  Nervous  and  Mental  Diseases." 


342  PRACTICAL  HYDROTHERAPY. 

perature  of  the  sheet  two  degrees  daily  until  60°  F.  is  reached,  at 
which  time  we  may  proceed  to  the  following  full  treatment :  Incandes- 
cent electric  light  bath,  vapor,  hot  air,  or  superheated  dry  hot-air  body 
apparatus  until  the  patient  perspires  very  freely ;  remove  to  the  hor- 
izontal rain  or  needle  bath  administered  at  a  temperature  of  100°  F. 
one  and  one-half  minutes,  rapidly  reduced  to  60°  F.  for  one-fourth 
to  one-half  minute.  As  soon  as  the  patient  reacts  to  this  treatment 
we  may  use  the  heating  procedure  and  follow  same  with  rain  bath  for 
its  general  effects,  and  where  it  is  possible  and  permissible,  the  Scot- 
tish or  alternating  douche  at  a  temperature  of  110°  to  120°  F.  for 
twenty  to  thirty  seconds,  alternating  with  the  temperature  of  60°  F. 
for  five  to  ten  seconds.  This  should  be  repeated  four  to  six  times, 
and  the  form  in  which  the  Scottish  should  be  used,  whether  as  fan  or 
jet,  must  be  determined  by  the  anatomical  region  affected.  Where 
possible,  the  jet  is  to  be  preferred.  The  writer  believes  the  super- 
heated dry  hot  air  and  incandescent  electric  light  bath  to  be  the  two 
best  forms  of  applying  the  heat  in  these  cases.  In  tic  douloureux  the 
author  has  followed  Dana  in  the  use  of  massive  doses  of  strychnia 
in  conjunction  with  iron,  and,  where  necessary,  morphia,  the  local 
use  of  the  fomentation,  general  applications  of  superheated  dry  hot 
air,  and  the  horizontal  rain  or  needle  bath,  carefully  guarding  the 
face  during  its  application,  with  a  compress  wrung  out  of  very  hot 
water  (120°  to  140°  F.).  This  method  has  in  my  hands  yielded  excel- 
lent results.  In  neuralgias  of  the  viscera  (stomach,  ovary,  uterus, 
testes,  rectum,  bladder,  etc.)  a  very  satisfactory  local  method  is  the 
use  of  the  very  hot  fomentation  (160°  F.)  over  the  affected  organ, 
followed  by  the  half  pack  for  thirty  minutes  at  a  temperature  of  110° 
to  130  F.  The  patient  should  drink  hot  water  freely,  and  the  hot 
enema   may  be   administered   with   advantage. 

In  cases  of  neuralgia,  after  recovery  we  may  with  advantage  send 
them  to  the  sea-shore  to  indulge  in  surf  bathing,  the  advantages  of 
which  are  many.  As  associated  procedures  of  value  we  may  mention 
massage,  galvanism,  high-tension  faradic  and  X-ray  treatment.  Among 
the  drugs  most  useful  are  iron,  arsenic  and  the  glycerophosphates. 

Meningitis;  Cerebral  Pachymeningitis;  Acute  Leptomeningitis; 

Tubercular  Meningitis;  Spinal  Pachymeningitis; 

Spinal  Meningitis. 

These  inflammatory  diseases  of  the  various  membranes  of  the 
cerebrum  and  spinal  cord  have  been  grouped  together  because  of  their 
similar  treatment,  their  names  indicating  the  membrane  or  membranes 
involved  and  its  location.  Meningitis  most  frequently  originates  from 
traumata,  purulent  disease,  caries,  syphilis,  acute  infections,  chronic 
alcoholism,  Bright's  disease,  insolation,  influenza  and  tuberculosis. 
It  is  usually  accompanied  by  headache,  delirium,  vomiting,  fever  (103° 


NERVES,  BRAIN  AND  SPINAL  CORD.  343 

to  104    i.  rapid  pulse,  retraction  of  the  head  and  abdomen,  the  tache 
cerebrate  and    Kernig's   sign.     The  outlook   is  unfavorable,  both   to 
life  and  the  many  disabilities,  palsies,  headache,  epilepsy  and  mental 
impairment  that  follow  in  its  wake.    The  patient  should  be  placed  in  a 
room  which  must  be  dark,  quiet,  cool,  well  ventilated,  and  in  which 
there  are  no  bright  lights  and  no  conversation.     A  much  better  prog- 
nosis  can  he  given  if  the  nurse  is  quiet,  gentle  and  interested.     The 
diet   should  be  liquid,  nourishing,  and  consist  of  milk,  gruel,  broths, 
koumyss,  custard,  etc.,  administered  at  regular  intervals.    During  con- 
valescence  the   patient  may   be    frequently   given   eggs,   cream,   toast, 
cereals,  minced  meat,  oysters,  chicken,  fish,   fruits,  breads  and  simple 
vegetables.     All  causal  conditions  must  be  treated,  and  where  cases 
are  of  septic  origin  surgical  intervention  is  necessary.     Where  a  spe- 
cific history  can  be  obtained,  mercury  should  be  administered,  pref- 
erably by  inunction.     In  the  spinal  variety  much  success  has  been  ob- 
tained   from   the   use    of    lumbar   puncture    and    hydrotherapy.      The 
method  of  Aufrecht  is  the  one  to  be  adopted.     Prepare  the  full  bath, 
filling  the  tub  with  water  at  a  temperature  of  95°  to  100°  F.     Place 
the  patient  in  the  tub  and  gradually  add  water  until  the  temperature 
reaches  104°  to  105°   F.,  or  hotter,  if  agreeable  to  the  patient.     The 
duration  of  the  bath  should  be  from  ten  to  fifteen  minutes.     The  ice 
helmet  must  invariably  be  applied  to  the  head  and  the  cold  compress 
to  the  nape  of  the  neck.     If  great  pain  or  tenderness  exist,  the  bath- 
tub should  be  cushioned  with  sheets  or  blankets,  and  the  patient  care- 
fully removed  to  and  from  the  tub  by  means  of  the  sheet.     Upon  re- 
moval  from  the  bath  do  not  dry  the  patient,  but  place  upon  a  dry 
sheet  and  carefully  cover  with  blankets,  in  which  he  is  to  remain  for 
one  hour.     These  baths,  according  to  Aufrecht,  should  never  be  ad- 
ministered in  the  early  morning  hours  or  late  evening.     The  rationale 
of  this  bath  is  to  draw  the  blood  from  the  brain  and  meninges  to  the 
skin ;  to  increase  the  activity  of  the  latter  and  the  secretion  from  the 
sweat  glands;  to  eliminate  large  quantities  of  toxins,  and  finally,  by 
acting  upon  the  cutaneous  sensory  nerve  terminals,  produce  an  ano- 
dyne and  sedative  effect.     Cases  are  reported  by  Aufrecht  and  Voro- 
chilisky  in  which  the  entire  course  of  the  disease  has  been  rendered 
mild  by  these  baths,  and  some  cases,  apparently  hopeless,  in  which, 
in  addition  to  this,  lumbar  puncture  was  performed,  the  recovery  was 
prompt  and  satisfactory.     It  has  been  noted  that  after  the  adminis- 
tration of  the  bath  the  circulation  improved,  the  heart  action  became 
better  and  the  mind  clearer.     While  the  author's  observations  have 
been  limited,  still  he  can  agree  with  Aufrecht  as  far  as  he  goes,  and 
believes  that  in  addition  the  hot  full  bath  possesses  another  feature 
too  little  considered  in  the  treatment  of  this  disease,  and  that  is  the 
relief  of  some  of  the  most  distressing  symptoms  that  cause  great  men- 
tal anguish  to  the  members  of  the  family  of  the  sufferer.    It  is  unques- 


344  PRACTICAL  HYDROTHERAPY. 

tionably  a  fact  that  even  though  the  outcome  in  the  case  is  unfavor- 
able, the  mitigation  of  convulsions,  delirium,  jactitation,  etc.,  is  much 
appreciated  by  the  onlooker,  and  the  physician  in  charge  will  fre- 
quently receive  praise  for  this  if  nothing  else  is  accomplished.  Where 
pyrexia  is  a  notable  feature  the  patient  should  have  the  cold  sponge 
several  times  daily  between  the  full  baths.  The  ice-cap  may  be  used 
continuously,  or  in  the  spinal  type  Chapman's  ice-bags  may  be  applied 
along  the  vertebras;  if  necessary,  the  scalp  should  be  shaved.  The 
chronic  sequelae  of  the  disease  are  best  met  by  proper  treatment,  de- 
tailed in  other  sections.      (See  Cerebro-Spinal  Meningitis.) 

Cerebral  Hemorrhage;  Cerebral  Apoplexy;  Cerebral 
Thrombosis;  Cerebral  Embolism. 

Cerebral  hemorrhage  or  apoplexy,  "  a  stroke,"  is  an  intracranial 
hemorrhage  from  the  bursting  or  rupture  of  a  blood-vessel,  followed 
by  an  escape  of  blood  into  the  cerebral  tissues,  causing  considerable 
pressure,  more  or  less  localized  destruction  of  brain  substance,  char- 
acterized by  sudden  onset,  unconsciousness,  irregular  and  noisy  res- 
piration, complete  relaxation  and  paralysis,  usually  hemiplegic,  the 
extent  and  location  of  which  depend  upon  the  size  and  position  of  the 
hemorrhage.  The  vast  majority  of  hemorrhages  within  the  brain 
occur  from  rupture  of  those  blood-vessels  that  supply  the  great  basal 
ganglia,  the  internal  capsule  and  white  matter  known  as  the  corona 
radiata.  Jt  is  a  disease  of  the  later  decades,  occurring  most  frequently 
in  the  aged,  those  under  forty  to  forty-five  years  usually  being  syph- 
ilitic. Heredity  has  some  influence,  but  the  so-called  "apoplectic 
build" — thick  neck,  fat,  florid  people — does  not  predispose  to  the 
attack.  The  principal  cause  is  an  arteritis,  fatty  or  atheromatous,  fol- 
lowed by  the  development  of  miliary  aneurisms,  which  rupture  under 
excessive  emotion,  overexertion,  attacks  of  indigestion  or  acute  alco- 
holism. Strong  contributing  factors  in  the  production  of  the  arteritis 
are  chronic  nephritis,  chronic  gout,  chronic  alcoholism  and  syphilis. 
Cardiac  hypertrophy  associated  with  arterial  disease  is  a  dangerous 
combination  for  the  production  of  cerebral  hemorrhage.  Immedi- 
ately after  the  "stroke"  the  patient  is  found  unconscious,  breathing 
stertorously,  one  side  paralyzed,  temperature  subnormal,  rising  later 
one  to  two  degrees  on  the  paralyzed  side.  In  from  two  to  six  hours 
the  patient  usually  regains  consciousness,  but  is  weak  and  confused. 
In  the  chronic  state  we  find  the  patient  a  "hemiplegic,"  with  paralysis 
of  arm  and  leg,  mild  sensory  symptoms,  mind  clear,  and  speech,  as  a 
rule,  uninvolved  or  slightly  so;  improvement  continues  for  some  time, 
the  leg  improving  more  rapidly  than  the  arm ;  there  is  rigidity,  the  re- 
flexes exaggerated,  ankle  clonus  and  contractions  present.  There  is 
always  danger  of  a  recurrence  of  an  attack,  owing  to  the  disease 
of  the  vascular  system — that  is  to  say,  the  causes  of  the  original  at- 


NERVES,  BRAIN  AND  SPINAL  CORD.  345 

tack  remain  effective.     The  association  of  chronic  nephritis  with  cere- 
bral hemorrhage  makes  the  prognosis  grave. 

Cerebral  embolism  and  cerebral  thrombosis,  causing  acute  soft- 
ening of  the  brain,  is  a  condition  brought  about  by  the  plugging  of  a 
blood-vessel  with  an  embolus  or  thrombus,  and  is  characterized  by  a 
sudden  seizure,  running  a  more  or  less  similar  course  to  that  of  cere- 
bral hemorrhage.  The  plugging  of  the  blood-vessel  causes  an  anemia 
of  the  area  to  which  it  is  supplied,  and  unless  the  collateral  circulation 
is  shortly  established  a  localized  or  focal  softening  takes  place.  Em- 
bolism arises  most  frequently  in  endocarditis,  infectious  fevers,  preg- 
nancy and  blood  dyscrasias,  while  gout,  syphilis,  lead  or  fatty  heart 
predispose  to  thrombosis.  Atheroma  is  a  frequent  cause.  The  onset 
is  sudden  ;  the  loss  of  consciousness  or  coma  is  less  deep  and  of  much 
shorter  duration.  There  is  an  absence  of  stertor,  flushed  face,  hard 
pulse.  Thrombosis  generally  gives  premonitory  warning,  especially 
if  syphilitic,  with  vertigo,  headache,  temporary  aphasia,  cranial  nerve 
palsies,  numbness  of  the  extremities;  hemiplegia  develops  slowly. 
These  attacks  frequently  take  place  without  loss  of  consciousness, 
and  may  occur  during  sleep.  After  embolic  plugging  there  are  more 
spastic  symptoms  and  fewer  mental  effects,  owing  to  youth  and  free- 
dom from  arterial  disease.  "Mental  symptoms  are  more  frequent  in 
thrombosis.  In  terminal  arteries  where  the  plugging  shuts  oft"  the 
entire  blood  supply,  the  anemia  is  followed  by  death  of  the  part,  or 
it  undergoes  necrobiosis,  followed  by  reddish-yellowish-white  soft- 
ening. Upon  the  situation  of  the  artery  in  which  the  embolus  or 
thrombus  lies  will  depend  a  number  of  symptoms,  localized  in  charac- 
ter, which  may  determine  whether  we  have  to  deal  with  diplegia,  hemi- 
plegia, aphasia,  etc.  The  chronic  stage  is  similar  to  the  chronic  stage 
of  cerebral  hemorrhage. 

The  writer  is  firmly  of  the  opinion  that  hydrotherapy  is  one  of  the 
most  powerful  and  successful  agents  for  the  prevention  of  cerebral 
hemorrhage,  embolism  and  thrombosis,  provided  it  is  persistently  em- 
ployed as  a  means  of  securing  health.  The  physiological  action  of 
hydrotherapy  upon  the  circulation  tends  to  keep  the  arteries  active 
and  elastic,  owing  to  the  powerful  influx  and  efflux  of  blood  to  and 
from  the  cutaneous  surface.  The  blood  vascular  "tone"  produced  by 
this  exercise  of  the  muscular  structures  of  the  blood-vessels  is  like 
the  action  of  exercise  in  the  prevention  of  stiffness  in  chronic  joint 
troubles.  It  is  certainly  a  well-established  fact  that  toxins  arising 
from  the  gastro-intestinal  tract,  and  other  poisons,  such  as  those  of  lead 
and  syphilis,  circulating  in  the  blood  stream  tend  to  produce  atheroma, 
arteritis,  and  final  sclerotic  changes,  until  we  have  fully  developed 
arterial  sclerosis.  In  the  author's  opinion,  for  the  reasons  just  enume- 
rated, hydrotherapy  exercises  an  influence  for  good  that  the  average 
general  practitioner  is  totally  unaware  of,  and  would  more  frequently 


346  PRACTICAL  HYDROTHERAPY. 

utilize  were  he  to  know  of  its  vast  power  in  the  prevention  of  those 
diseases  that  have  molecular  decay  and  fibrosis  as  their  terminal  stage. 
From  an  experience  in  nowise  limited,  the  author  has  taken  opportu- 
nity to  observe  the  great  value  of  this  agent  as  a  preventive  of  cerebral 
arterial  disease.  Where  it  is  suspected  that  an  attack  of  hemorrhage, 
thrombosis  or  embolism  is  supervening,  the  patient  should  be  at  once 
treated  as  though  the  attack  had  actually  taken  place,  if  good  is  to 
be  secured. 

Patients  who  have  actually  sustained  an  attack  of  cerebral  hemor- 
hage,  thrombosis  or  embolism,  should  at  once  be  placed  in  bed  at  per- 
fect rest,  with  the  head  and  shoulders  slightly  raised,  with  no  con- 
striction of  clothing  or  night  garments,  in  a  room  that  is  quiet  and 
darkened.  Where  there  is  much  stertor  and  an  excess  of  the  secre- 
tions of  the  mouth  and  throat,  he  should  be  turned  slightly  to  one 
side,  so  as  to  allow  the  tongue  and  palate  to  fall  forward  and  the 
saliva  and  secretions  to  drain  outward.  Every  care  must  be  exercised 
to  keep  the  mouth  clean  and  antiseptic,  the  patient  well  protected 
from  draughts  and  exposure  to  cold,  as  these  cases  are  especially  prone 
to  an  attack  of  pneumonia.  Ice  may  be  applied  over  a  cephalic  com- 
press, best  by  means  of  a  rubber  cap  that  is  bowl-shaped  (see  cut), 
and  which  can  be  so  arranged  as  to  produce  no  pressure  upon  the 
head.  The  ordinary  rubber  coil-cap  or  Leiter  coils  may  be  employed, 
using  ice-water  which  is  allowed  slowly  to  run  through.  In  addition, 
the  trunk  compress  at  a  temperature  of  120°  F.  is  to  be  applied,  well 
protected  by  blankets  or  rubber  tissue  to  prevent  the  loss  of  heat. 
The  lower  extremities  should  be  wrapped  in  blankets,  and  hot-water 
bags  or  bottles  applied  to  the  feet.  Where  it  is  possible,  it  is  best  to 
apply  to  the  extremities  very  hot  circular  compresses  wrung  out  of 
water  at  a  temperature  of  140°  F.,  in  which  a  liberal  amount  of  mus- 
tard has  been  stirred.  In  addition,  a  tepid  enema  can  be  given  and 
two  minims  of  croton  oil,  or  a  quarter  of  a  grain  of  elaterium  admin- 
istered. Tincture  of  aconite,  or,  what  is  better,  granules  of  aconitine 
(gr.  1-134 — .0005),  dissolved  in  a  teaspoonful  of  water,  can  be  given 
every  fifteen  to  twenty  minutes  until  a  distinct  impression  is  made 
upon  the  pulse.  Where  possible,  no  food  should  be  taken  for  twenty- 
four  hours,  and  after  this  time  the  diet  is  to  be  liquid  for  at  least 
three  or  four  days.  It  has  been  the  writer's  opinion  that  it  is  ad- 
vantageous to  administer  water  in  very  small  quantities  as  soon  as  the 
patient  becomes  conscious,  and,  in  addition  to  the  hydrotherapeutic 
measures  suggested,  give  nitroglycerine  (1-100  of  a  grain)  three  or 
four  times  daily.  As  the  patient  improves,  we  enter  the  chronic  stage, 
and  are  now  called  upon  to  treat  the  general  condition  as  well  as 
the  "hemiplegia."  For  this  the  writer  usually  commences  with  the 
half  pack  at  a  temperature  of  90°  F.  for  thirty  minutes  once  daily, 
decreasing  the  temperature  to  70°   F.   and   lengthening  the  duration 


NERVES,  BRAIN  AND  SPINAL  CORD.  347 

until  forty-five  to  sixty  minutes  is  reached.  As  soon  as  the  patient 
reacts  to  this  treatment  we  may  administer  the  half  bath  at  a  tem- 
perature of  85  to  80°  I\,  applying  friction  to  the  lower  limbs  and 
finishing  the  treatment  with  an  affusion  to  the  spine  at  70°  F.  In 
ambulator  cases  it  has  been  my  experience  that  the  most  satisfactory 
method  of  treatment  is  the  following:  Incandescent  electric  light  hath 
until  perspiration  takes  place,  followed  by  the  rain  hath  at  a  tem- 
perature of  100°  F.  for  one  to  one  and  one-half  minutes;  reduce  to 
70  F.  for  one-fourth  to  one-half  minute.  The  action  of  this  hath 
is  to  keep  the  skin  and  kidneys  very  active  and  at  the  same  time  lower 
arterial  tension,  hut  in  order  to  secure  this  desideratum  the  author 
continues  the  use  of  nitroglycerine  in  an  alcoholic  solution  of  five 
grains  to  the  ounce,  of  which  he  gives  five  to  six  drops  after  meals, 
or  uses  sodium  nitrite.  In  embolism  and  thrombosis,  in  addition  to 
the  nitroglycerine,  we  may  use  heart  tonics,  of  which  the  fat-free 
tincture  of  digitalis  is  by  far  the  hest.  The  patient  should  lead  a 
quiet  and  rather  inactive  life,  taking  sufficient  exercise  only  to  secure 
functional  activity.  As  a  rule,  warm  and  equable  climates  are  the 
best,  and  '•!  these  California,  Xew  Mexico,  San  Antonio,  Florida,  the 
Bahamas,  the  Riviera,  etc.,  are  suitable  localities.  Where  we  have  to 
deal  with  cases  in  the  chronic  stage,  in  whom  contractures  are  trouble- 
some, whether  they  result  from  the  absence  of  or  improper  treatment, 
we  may  employ  the  warm  full  bath,  in  which  the  attendant  gently 
masses  the  limbs  and  stretch.es  them.  The  author  believes  that  he 
has  seen  some  benefit  result  from  this  course  of  treatment.  In  addi- 
tion, we  may  use  massage,  the  faradic,  galvanic  and  static  currents, 
applied  foi  their  general  and  local  effects.  Internally,  the  iodides 
and  strychnia  hypodermically  are  indicated.  Physostigma  sometimes 
assists  in  removing  the  contractures. 

Acute  Myelitis;   Acute  Poliomyelitis;    Polioencephalitis  Superior; 

Landry's  Paralysis;  Acute  Bulbar  Paralysis; 

Caisson  Disease. 

This  group  of  diseases  of  an  inflammatory  character  is  treated 
on  the  same  general  principles,  and  for  that  reason  the  author  has 
grouped  them  together  for  convenience  and  to  avoid  repetition. 

Acute  myelitis  is  an  acute  softening  of  the  spinal  cord,  followed 
by  secondary  inflammation,  generally  transverse,  and  involving,  as  a 
rule,  one  or  twro  inches  of  the  cord.  The  inflammation  is  diffuse,  af- 
fecting both  gray  and  white  matter  of  the  cord,  and  has  for  its  eti- 
ological factors  exposure  to  cold,  especially  while  undergoing  severe 
muscular  strains ;  infective  fevers,  septic  infection  and  syphilis.  Trauma 
and  syphilis  are  by  far  the  most  important  of  the  causes.  Myelitis 
usually  reaches  its  climax  in  a  few  days,  remains  stationary  from  fif- 
teen to  thirty  days,  and,  should  the  patient  live,  we  may  expect  im- 


348  PRACTICAL  HYDROTHERAPY. 

provement.  This  sets  in  slowly,  provided  there  has  been  no  great 
extension  up  and  down  the  cord,  involving  vital  centers  and  pro- 
ducing conditions  unfavorable  to  life,  such  as  vesical  and  rectal  in- 
volvement, with  subsequent  kidney  disease,  etc.  Most  cases  pass  into 
the  chronic  stage ;  others  get  almost  entirely  well ;  some  regain  power 
and  resemble  cases  of  ataxic  paraplegia.  The  cord  appears  soft, 
swollen,  red,  hyperemic,  with  distension  of  blood-vessels,  swollen 
neuraxons,  white  and  red  blood  cells,  etc.     The  prognosis  is  guarded. 

Acute  poliomyelitis  is  an  acute  disease  of  the  anterior  cornua  of 
the  spinal  cord,  characterized  by  motor  paralysis  of  rapid  onset,  fol- 
lowed by  muscular  wasting  and  absence  of  sensory  symptoms,  reaction 
of  degeneration  and  loss  of  the  reflexes.  It  occurs  most  frequently  in 
children,  other  etiological  factors  being  exposure  to  wet,  season  (June 
to  September),  infectious  diseases,  and  possibly  a  predisposing  influ- 
ence of  greater  strain  upon  the  spinal  motor  centers,  due  to  the  ex- 
cessive use  of  the  muscular  system.  There  is  a  stage  of  invasion, 
with  extensive  muscular  involvement ;  a  stationary  period ;  a  period  of 
retrocession  and  of  improvement,  leaving  one  or  more  members  in- 
volved ;  and  finally  a  chronic  stage.  The  disease  is  an  acute  exudative 
inflammation  followed  by  destruction  of  tissue  without  pus  forma- 
tion, affecting  chiefly  the  anterior  cornuas  of  the  spinal  cord,  certain 
cell  groups  in  certain  regions  receiving  the  brunt  of  the  disease,  de- 
struction of  the  neuron  bodies  taking  place.  Prognosis  is  good,  though 
complete  and  perfect  recover}-  is  rarely  attained. 

Caisson  disease,  or  diver's  paralysis,  is  a  more  or  less  complete 
paraplegia,  occurring  in  those  who  work  in  caissons  under  very  heavy 
atmospheric  pressure,  ranging  from  fifteen  to  fifty  pounds,  and  is 
usually  brought  about  by  the  too  sudden  return  to  or  "locking  out" 
of  the  normal  atmosphere.  Different  persons  vary  in  their  suscepti- 
bility to  the  action  of  changes  in  atmospheric  pressure.  The  onset 
is  usually  attended  with  much  pain  in  the  legs,  nausea,  vomiting,  head- 
ache and  dizziness.  The  picture  soon  resembles  that  of  acute  myelitis, 
and  lasts  from  a  few  hours  to  many  weeks.  In  three  cases  seen  by 
the  author  recovery  was  complete.  For  months  afterwards  neuras- 
thenoid  symptoms  of  fullness  in  the  head,  vertigo,  fatigue  of  the  limbs 
and  tenderness  of  the  feet  existed.  Under  the  heavy  atmospheric 
pressure  the  blood  is  driven  from  the  surface  to  the  internal  viscera, 
the  sudden  change  of  pressure  causing  a  rapid  reflux  to  the  surface, 
this  producing  in  the  inelastic  spinal  circulation  a  congestion,  followed 
by  punctate  hemorrhages  accompanied  by  some  destruction  of  nerve" 
tissue. 

In  the  treatment  of  this  group  of  diseases  rest  must  be  secured, 
and  to  this  end  the  patient  should  be  at  once  put  to  bed,  calomel  and 
a  saline  administered.  Scrupulous  cleanliness  is  essential,  the  patient 
being  carefully  watched  to  see  if  any  red  places  form  upon  the  back, 


NERVES,  BRAIN  AND  SPINAL  CORD.  349 

buttocks  or  limbs,  the  aim  being  to  prevent  the  Formation  of  bedsores. 
This  end  will  be  materially  aided  by  placing  the  patient,  if  possible, 
upon  a  water  bed,  and  where  this  cannot  be  obtained  the  using  of  air 
cushions.  The  room  should  be  moderately  darkened  and  quiet  main- 
tained. Special  pains  are  to  be  taken  to  keep  the  sufferer  warm,  and 
in  the  case  of  children  suffering  from  poliomyelitis  the  limbs  should 
be  wrapped  in  cotton  or  wool.  Diaphoresis  should  be  promoted  by 
the  free  drinking  of  water  and  the  administration  of  pilocarpine.  In 
some  cases  tincture  of  aconite  will  serve  the  purpose  of  promoting 
perspiration,  and  at  the  same  time  combating  the  inflammatory  process 
in  the  spinal  cord.  The  diet  should  be  absolutely  liquid  in  the  early 
stages,  it  being  the  rule  with  the  author  to  never  permit  the  use  of 
meat  until  the  inflammation  has  entirely  subsided;  gruels,  barley-water, 
infant  foocis,  purees  of  vegetables  strained,  milk,  tropon,  plasmon 
and  similar  preparations  are  very  useful.  The  bladder  should  be  con- 
stantly and  carefuily  watched,  and  where  there  is  evidence  of  the 
slightest  irritation  or  the  microscope  shows  the  presence  of  pus,  irriga- 
tions are  to  be  commenced,  using  a  hot  saline  or  hot  boric  acid  solution. 
Bed-sores  can  only  be  prevented  by  perfect  cleanliness,  bathing  and 
the  judicious  avoidance  of  pressure  by  frequent  change  of  position. 

Hydrotherapy  is  most  valuable  in  the  treatment  of  these  diseases 
in  the  early  stage,  and  tends  to  prevent  complications  as  well  as  acting 
in  a  reparative  manner.  In  every  case  the  coil,  compress  and  fomenta- 
tion can  be  used.  The  treatment  may  be  given  as  follows :  Apply  the 
fomentation  to  the  spine  at  a  temperature  of  140°  to  150°  F.  for  ten 
to  fifteen  minutes,  following  same  with  the  trunk  compress  at  a  tem- 
perature of  50°  to  60°  F.,  over  which  we  can  apply  to  the  spinal  col- 
umn the  cold  water  coil  or  rubber  ice-bag  or  Chapman's  spinal  ice-bag. 
The  author  believes  that  this  treatment  has  marked  prophylactic  in- 
fluences, and  in  one  case  he  has  seen  signal  good  result  from  the 
treatment,  in  several  others  amelioration  of  the  symptoms.  It  cer- 
tainly tends  to  prevent  bed-sores.  The  ideal  method  of  treating  these 
cases  is  by  means  of  the  continuous  bath  as  originated  and  perfected 
by  Reiss.  It  is  comparatively  easy  to  rig  up  a  hammock  in  an  ordinary 
bath-tub  by  fastening  a  sheet  to  the  sides  and  covering  the  tub  with 
another  sheet  or  cloth  to  prevent  the  too  rapid  cooling  of  the  water 
and  breezes  from  striking  upon  the  patient.     (See  Continuous  Bath.) 

In  an  endeavor  to  relieve  pressure,  promote  cleanliness  and  bring 
about  healing,  Reiss  immersed  patients  in  a  neutral  bath  at  a  tem- 
perature of  94°  to  96°  F.  for  hours,  with  the  result  that  the  sores 
healed  and  the  other  trophic  phenomena  disappeared.  Where  this 
treatment  can  be  instituted  we  should  commence  with  an  immersion 
of  one  hour  and  an  intermission,  increasing  the  immersion  until  the 
patient  remains  from  early  morning  until  bedtime  in  the  bath,  and  if 
the  case  is  serious  the  entire  twenty-four  hours.     It  was  during  his 


350  PRACTICAL  HYDROTHERAPY. 

treatment  of  bedsores  that  Reiss  noticed  the  marked  improvement 
of  the  continuous  bath  upon  organic  diseases  of  the  nervous  system. 
Stearne  recommends  in  poliomyelitis  the  immediate  use  in  the  acute 
stages  of  the  high-tension  faradic  current,  having  personally  assured 
the  author  of  considerable  success  in  its  use.  In  those  cases  resulting 
from  caisson  disease2  it  is  needless  to  say  that  prevention  and  pro- 
phylaxis are  best  brought  about  by  the  slow  "locking-out"  process. 
The  subacute  effects  and  chronic  conditions  that  result  from  this  in- 
flammation must  be  treated  upon  the  principles  laid  down  under  the 
heads  of  Chronic  Myelitis  and   Neurasthenia. 

Chronic  Myelitis;  Chronic  Stage  of  Poliomyelitis;  Chronic 
Stage  of  Acute  Myelitis. 

Chronic  myelitis,  as  its  name  indicates,  is  a  chronic  inflammatory 
disease  of  the  spinal  cord,  or  a  chronic  reparative  stage  of  acute  mye- 
litis, and  may  be  transverse,  diffuse,  disseminated,  marginal  or  cen- 
tral. It  may  originate  from  compression,  and  when  this  is  the  case 
it  has  that  name  as  a  prefix — compression  myelitis.  Chronic  myelitis 
originating  as  a  primary  disease — that  is  de  novo — is  a  rare  disease, 
for  it  usually  occurs  secondary  to  an  acute  attack.  I+  is  a  disease  of 
adult  life,  more  frequent  in  males,  probably  because  of  the  greater 
frequency  to  syphilitic  infection.  It  may  follow  the  acute  infectious 
diseases,  lead  and  trauma.  The  secondary  form  is  really  a  chronic 
stage  of  the  acute  form  of  inflammation  that  follows  softening,  hem- 
orrhage or  trauma.  The  pathology  is  that  of  a  chronic  inflamma- 
tion, with  the  spinal  cord  gray,  discolored,  and  shrunken  at  the  level 
of  the  lesion,  harder  than  the  normal  to  the  touch.  Nerve  tissue  is 
lost,  and  a  secondary  growth  of  connective  tissue  takes  place,  the 
blood-vessels  and  their  walls  being  increased  and  greatly  thickened. 
Granular  detritus,  granule  cells  and  neuron  bodies  in  various  degrees 
of  degeneration  are  found,  those  parts  adjacent  to  the  area  affected 
being  markedly  congested.  As  a  result  of  the  inflammation,  second- 
ary ascending  and  descending  degenerations  take  place.  The  prog- 
nosis  varies,  many  cases  reaching  partial  usefulness  and  prolonging 
their  lives  for  periods  ranging  from  five  to  twenty  years,  this  being 
especially  true  of  dorsal  myelitis,  which  is  the  most  favorable  form. 

The  chronic  stage  of  poliomyelitis  usually  begins  with  the  sub- 
sidence of  the  stationary  period  and  the  commencement  of  improve- 
ment, the  chronic  stage  continuing  from  four  to  iwelve  or  more 
months,  the  members  most  often  affected  by  the  acute  disease  being 
the  lower  limbs.  The  treatment  may  commence  with  the  judicious 
combination  of  hydrotherapy,  rest  and  exercise.  Where  the  patient 
has  been  placed  in  the  continuous  bath  of  Reiss  we  may  commence 

2   Smith,    A     II.:    "Physiologic,    Pathologic    and    Therapeutic    Effe^s    of    Compressed    Air," 
1894;    Heller,   Mager   and   Von    Schrulter:    "Luftdrucker   Krankungen,"   Vienna,    1900. 


NERVES,  BRAIN  AND  SPINAL  CORD.  351 

with  the  use  of  friction  two  or  three  times  daily  for  ten  minute-, 
gradually  increasing  the  length  of  time  until  twenty  or  thirty  minutes 
is  reached.  The  results  obtained  by  this  method  with  the  chronic 
cases  have  been  mojt  satisfactory.  With  the  subsidence  of  the  inflam- 
mation and  the  administration  of  friction  we  may  gradually  reduce 
the  temperature  of  the  water  from  94° — that  is  to  say,  neutral — to 
the  temperature  of  88°  F.,  reducing  one  degree  daily  until  this  has 
been  attained.  Patients  should  be  kept  in  the  hammock  from  early 
in  the  morning  until  bedtime. 

A  most  satisfactory  method  of  treating  these  cases  is  the  use  of 
the  half  bath  at  a  temperature  of  from  82°  to  65°  F.,  from  five  to  ten 
minutes'  duration.  Commence  with  the  temperature  of  82°  F.  and 
reduce  two  degrees  daily  until  60°  F.  is  reached,  at  which  time  the 
duration  of  the  bath  should  be  lengthened  until  it  is  given  for  the 
full  ten  minutes.  It  is  essential  that  during  its  administration  the 
limbs  should  be  constantly  rubbed  or  chafed — that  is  to  say,  fricti  m 
applied  during  the  bath.  We  may  finish  the  bath  with  an  affusion 
to  the  spine  at  60°  F.  Reaction  must  be  secured.  In  the  same  manner 
at  the  same  temperatures,  and  for  the  same  duration,  we  may  apply 
the  half  bath  in  which  twenty  to  thirty  pounds  of  common  salt  has 
been  dissolved,  finishing  the  bath  with  an  affusion  at  60°  F.  and 
securing  reaction.  Care  should  be  exercised  to  not  rub  the  limbs  too 
vigorously,  as  their  trophic  power  is  small.  The  writer  is  satisfied 
from  personal  experience  that  the  Nauheim  or  carbon  dioxide  baths 
at  a  temperature  of  95°  to  84°  F.  act  favorably  in  this  affection.  We 
may  start  with  the  temperature  of  95°  F.,  a  duration  of  four  minutes, 
and  the  bath  containing  100  grams  of  acid  and  alkali,  decreasing  the 
temperature  two  degrees,  increasing  the  duration  one  minute  and  the 
acid  and  alkali  100  grams  each  bath  until  a  temperature  of  84°  F., 
duration  of  ten  minutes  and  a  strength  of  500  to  700  grams  of  acid 
and  alkali  are  reached.  There  is  a  sense  of  warmth,  increased  cir- 
culation, some  better  power,  and  a  general  feeling  of  comfort  succeed- 
ing the  use  of  these  baths.  Care  should  be  taken  between  times  to 
keep  the  limbs  warm,  and  to  this  end  the  feet  are  clothed  in  warm 
socks  or  stockings  and  canton  flannel  or  woolen  undergarments  worn. 
As  a  part  of  the  system  of  treatment  and  as  the  patient  progresses 
we  may  commence  the  use  of  massage,  galvanism,  faradism  and 
sinusoidal  electricity.  Suspension  sometimes  gives  excellent  results, 
and  in  some  instances  orthopedic  apparatus  such  as  braces  may  be 
advantageously  employed.  Children  suffering  from  acute  poliomye- 
litis may  be  taught  the  use  of  their  limbs  by  the  use  of  suspension 
trolley  apparatus.  With  the  increase  of  power  patients  must  be  taught 
to  walk,  exercise  and  use  the  limbs,  this  being  accomplished  by  means 
of  gymnastics,  tricycles,  etc.  Adults  should  be  taught  the  use  of 
crutches  and  made  to  walk  with  them  and  the  aid  of  an  attendant. 


352  PRACTICAL  HYDROTHERAPY. 

Where  they  can  be  carried  out  the  Paradeschritt  of  Fraenkel,  or  the 
so-called  "Fraenkel  exercises,"  may  be  employed  with  great  satisfac- 
tion. Should  patients  desire  a  change  of  air  and  scenery,  we  may 
send  them  with  advantage  to  the  sea-shore,  where  they  should  remain 
in  the  open  air  and  sunlight,  using  the  sea-water  to  continue  the  half 
baths  previously  mentioned. 

When  the  patient  reaches  the  ambulatory  stage  of  his  chronic 
condition  we  may  commence  the  use  of  active  hydrotherapy,  such 
as  the  administration  of  the  electric  light  bath  until  perspiration  takes 
place,  followed  by  the  horizontal  rain  bath  at  a  temperature  of  100° 
for  one  and  one-half  minutes,  pressure  twenty  pounds,  reduced  to 
a  temperature  of  70°  F.  for  one-fourth  to  one-half  minute.  Patients 
frequently  gain  great  relief  from  the  girdle  sensation,  sensory  dis- 
turbances and  muscular  spasm  by  the  application  of  a  gentle  douche 
or  spray  at  a  temperature  of  70°  F.  as  a  "finishing"  treatment  to  the 
above.  Where  this  does  not  prove  effective  we  may  apply  the  fo- 
mentation over  the  affected  part  for  ten  minutes,  followed  by  a 
partial  or  half  pack  or  a  compress  at  a  temperature  of  70°  F.  All 
cold  applications  must  be  carefully  graduated  to  suit  the  case,  and 
should,  in  my  opinion,  never  be  applied  but  once  daily.  Where 
patients  do  not  respond  well  to  active  hydrotherapeutic  measures  in 
the  chronic  stage  we  may  administer  the  half  pack.  Commence  with 
a  temperature  of  96°  F.  and  a  duration  of  fifteen  minutes,  gradually 
reducing  the  temperature  two  degrees  daily  and  lengthening  the  dura- 
tion five  minutes  until  70°  F.  and  one  hour's  duration  are  reached. 
We  may  at  the  same  time  administer  tonic  drugs  in  the  shape  of  iron, 
quinine,  strychnine  and  phosphorus. 

It  is  hardly  necessary  to  remark  that  all  treatment  must  be  most 
patiently  and  persistently  followed  out,  the  bladder  carefully  watched 
and  irrigated,  the  nerve  tone  improved  by  all  tonic  measures,  nutri- 
tion stimulated,  the  patient  trained  to  combat  the  disease,  mental  and 
moral  control  exercised,  and  the  circulation  kept  at  its-  highest  and 
most  active  point.  This  is  best  accomplished  by  the  hydrotherapeutic 
measures  detailed  above,  in  conjunction  with  a  general  system  that 
embraces  massage,  electrotherapy,  exercise,  and  such  medicinal 
measures  as  are  needed. 

Chronic  Degenerative  Spinal  Diseases;    Locomotor  Ataxia;    Spastic 

Spinal     Sclerosis;     "Lateral    Sclerosis";     Combined     Spinal 

Scleroses;  Ataxic  Paraplegia;  Multiple  or  Disseminated 

Scleroses;  Ataxic  Paraplegia;  Multiple  or  Disseminated 

Ataxia;     Amyotrophic     Lateral     Sclerosis; 

Chronic    Muscular    Atrophies. 

Locomotor  ataxia  is  a  chronic  spinal  disease  due  to  a  primary 
degeneration  of  the  sensory  neurons  located  in  the  posterior  columns 


NERVES,  BRAIN  AND  SPINAL  CORD.  353 

of  the  spinal  cord,  the  sclerosis  being  secondary  to  the  degeneration 
of  the  neuraxon.     It  is  characterized  by  incoordination,  pains,  anes- 
thesia, visceral,  trophic,  and  other  symptoms.     The  disease  is  one  of 
adult  life,  occurring  most  frequently  between  thirty  and  fifty.     Ex- 
posure to  wet  and  cold,  over-muscular  exertion,  excessive  dancing, 
railroad    traveling,    and    irregular    living    are    predisposing    causes. 
Syphilis  has  by  far  the  most  important  influence  in  the  production  of 
the  disease,  for  it  is  especially  prone  to  occur  in  syphUitics  (60  to  90 
per  cent.),  though  it  is  not  a  syphilitic  disease,  this  merely  predis- 
posing the  neural  elements  to  degeneration  by  altering  their  physio- 
logical condition.     It  occurs  mostly  in  the  intelligent  and  cultivated 
classes  and  in  those  subjected  to  causes  producing  leg  weariness.    The 
pathology  shows  a  characteristic  change  in  the  spinal  cord,  posterior 
spinal  ganglia,  posterior  nerve  roots,  and  to  a  certain  extent  in  the 
peripheral  nerves.     Upon  section  the  spinal  Cord  shows  the  shrunken 
and  grayish  appearance  in  the  posterior  column.     In  these  columns 
the  white  matter  has  been  seriously  affected,  the  neuraxons  having 
to  a  great  extent  disappeared,  their  place  being  taken  by  connective 
and  neuroglial  tissue.     The  question  as  to  whether  syphilis  is  a  cause 
of  locomotor  ataxia  has  been  discussed,  and  it  may  be  said  that  its 
action  is  certainly  that  of  predisposing  to  the  degenerative  condition; 
in  fact,  locomotor  ataxia  is  the  debris  left  in  the  wake  of  the  storm. 
As  a  result  of  leutic  infection  there  is  a  predisposition  of  the  nerve 
tissue  tending  to  decay  and  death.     As  the  degeneration  takes  place, 
nature,  abhorring  a  vacuum,  fills  in  with  sclerotic  tissue.     The  diet 
should  be  generous  and  as  far  as  possible  little  restriction  placed  upon 
it  consistent  with  the  state  of  the  digestive  system.     It  should  be  a 
mixed  one  in  which  vegetables  and  fats  predominate ;  dairy  products, 
especially  milk  and  butter,  should  be  freely  used.       Much  has  been 
written  with  regard  to  the  use  of  stimulants  in  these  cases ;  it  is  best 
to  give  no  tea,  coffee,  beer,  wines,  liquors  or  tobacco,  but  extended 
observation  has  taught  me  that  judgment  must  be  used,  especially  in 
cases  where  there  has  been  long-continued  use  of  these  articles.     If 
moderate  use  does  no  harm  we  must  remember  that  taking  them  away 
robs  the  patient  of  a  great  luxury.    Rest  is  an  essential  element  in  the 
treatment  of  these  cases,  it  being  best  to  secure  nine  to  twelve  hours 
daily.     Early  to  bed  and  late  to  rise  is  a  good  motto.     Very  active 
walking  must  be  avoided,  and  any  strain  upon  the  spine  or  legs  is 
absolutely  contraindicated.     Of  general  exercises,  driving  during  the 
worst  stages  and  golfing  during  convalescence  are  probably  the  best. 
Care  must  be  exercised  in  general  hygiene.     Cold  should  be  avoided; 
warm  clothing  and  underwear  worn  in  winter.     When  the  ground  is 
wet  or  slick  gum  shoes  are  essential.     Corns  should  never  be  cut.     In 
summer   light   cool   underwear   and  thin   clothing  are   advisable.      A 
close  study  should  be  made  of  how  to  improve  the  general  nutrition, 


354  PRACTICAL  HYDROTHERAPY. 

as  this  will  aid  the  neural  elements  to  quicker  and  better  assert 
themselves. 

The  treatment  resolves  itself  into  one  of  mechanics  and  nutrition. 
There  is  no  question  but  what  hydrotherapy  is  of  unusual  value  in 
these  cases.  It  is  usually  best  to  start  the  patient  upon  the  use  of  the 
half  bath,  the  tub  being  filled  to  a  depth  of  about  twelve  or  fourteen 
inches  with  water.  Commence  with  a  temperature  of  85°  F.  and  a 
duration  of  three  minutes.  While  the  patient  is  in  the  bath  he  should 
steady  himself  by  holding  to  the  sides  of  the  tub,  the  attendant  at  the 
same  time  vigorously  rubbing  the  lower  extremities,  kneading  and 
masseing  the  deeper  structures  as  well  as  the  superficial  ones.  The 
bath  is  finished  by  an  affusion  of  cold  water  poured  down  the  spine. 
Reduce  the  temperature  one  degree  daily  until  65°  F.  is  reached,  and 
at  the  same  time  lengthen  the  duration  of  the  bath  to  five  or  even 
seven  minutes.  The  spinal  action  may  be  enhanced  by  a  previous  salt 
rub.  The  bath  is  finished  by  hard  friction  with  warm  Turkish  towels. 
The  action  upon  the  body  of  the  agitated  water,  accompanied  by 
friction,  stimulates  the  peripheral  nerves,  dilates  the  superficial  blood- 
vessels, deepens  respiration,  increases  oxygenation,  exercises  a  calming 
as  well  as  stimulating  effect  on  the  sensory  nerves,  removing  mus- 
cular and  nervous  debility.  Of  recent  years  the  author  has  found 
the  Nauheim  or  carbonic  acid  baths  to  be  of  especial  benefit  to  these 
cases,  provided  there  is  no  irritative  phenomena  present.  These  baths 
are  usually  administered  three  times  a  week,  as  follows :  Commence 
with  a  temperature  of  94°  F.  for  five  minutes  with  a  bath  to  which 
200  grams  of  acid  and  alkali  have  been  added.  Lengthen  the  duration 
one  minute  and  increase  the  acid  and  alkali  100  grams  each  bath 
until  a  duration  of  ten  minutes  and  a  strength  of  500  to  600  grams  of 
acid  and  alkali  are  reached.  It  will  be  found  that  these  baths  act  in 
the  same  manner  as  the  half  bath  but  more  rapidly. 

Patients  who  react  well,  who  have  sufficient  flesh,  who  are  full- 
blooded  and  strong,  may  be  given  more  active  hydriatic  procedures. 
My  preference  is  for  the  following  treatment :  The  incandescent 
electric  light  bath  until  mild,  sensible  perspiration  ensues,  followed 
by  the  circular  or  horizontal  rain  bath  at  a  temperature  of  100°  to 
102°  F.  for  one  and  one-half  minutes,  pressure  twenty-five  to  thirty 
pounds,  and  gradually  reduced  to  70°  to  60°  F.  as  the  patient  pro- 
gresses. The  douche,  as  a  rule,  is  not  generally  employed,  and  is  in 
many  cases  poorly  borne,  although  it  has  been  strongly  recommended 
by  Charcot.  The  douche,  with  care,  may  be  employed,  but  it  is  a 
powerful  stimulating  procedure,  calling  into  action  nearly  every  physi- 
ological function ;  it  arouses  and  moves  to  healthy  action  the  nervous 
centers,  deepens  the  respiration  and  increases  the  circulation  by  its 
local  thermic  massage.  It  may  be  preceded  by  the  electric  light  bath. 
The  douche  can  be  administered  at  much  lower  temperatures,  owing  to 


NERVES,  BRAIN  AND  SPINAL  CORD.  355 

its  mechanical  effect,  which  increases  the  rapidity  of  reaction.  In  these 
cases  the  presence  of  rosy  skin,  full  pulse,  sense  of  well-being  and 
increase  of  activity  show  that  the  proper  end  has  been  attained. 

Where  gastric  crises  exist  they  may  oftentimes  be  relieved  by  the 
application  of  the  very  hot  fomentation  (140°  F.)  to  the  abdomen 
two  or  three  times  daily,  followed  by  the  trunk  compress  at  a  temper- 
ature of  70°  F.  for  thirty  to  sixty  minutes.  Local  pains  may  likewise 
be  removed  by  the  application  of  the  very  hot  fomentation,  followed 
by  the  compress  at  70°  F.  or  the  use  of  the  Scotch  or  alternating 
douche  at  a  temperature  of  120°  F.  for  ten  to  fifteen  seconds,  followed 
by  a  temperature  of  70°  to  60°  F.  for  three  to  five  seconds,  with  four 
to  six  alternations.  Paresis  of  the  bladder  is  best  managed  by  daily 
irrigations  of  hot  saline  or  boric  acid  solution.  Trophic  changes,  such 
as  Charcot's  joints,  must  be  met  by  the  application  of  the  fomentation 
to  the  part  once  or  twice  daily,  followed  by  the  circular  compress  at 
a  temperature  of  70°  F.  for  one  hour,  in  addition  to  mechanical 
support,  galvanism  and  sinusoidal  electricity.  General  hot  baths  are 
not  indicated,  and  should,  as  a  rule,  be  avoided.  Where  patients  are 
the  subjects  of  profound  toxemia  we  may  with  advantage  administer 
the  electric  light  bath  until  perspiration  takes  place,  followed  by  the 
horizontal  rain  bath  at  100°  F.  for  one  and  one-half  minutes,  reduced 
to  70°  F.  for  one-fourth  minute ;  reduce  temperature  two  degrees 
daily  until  60°  F.  is  reached,  maintaining  a  pressure  of  twenty-five 
pounds.  In  the  management  of  these  diseases  hydrotherapy  becomes 
most  effective  in  conjunction  with  other  treatment,  especially  massage, 
electricity,  suspension,  gymnastics — the  exercises  commonly  known  as 
the  "Fraenkel  method." 

The  main  difficulty,  handicap  and  burden  of  the  ataxic's  life  is 
the  question  of  locomotion.  Allow  him  the  use  of  his  extremities  and 
he  may  lead  a  useful  and  ordinarily  active  life,  but  when  he  reaches 
the  stage  of  canes,  crutches  and  a  constant  attendant  with  an  invalid's 
chair,  life  holds  little  that  is  bright  and  rosy,  and  just  at  this  time  he 
becomes  most  despondent,  hopeless,  introspective ;  his  strength  of 
will,  fortitude  and  hope  desert  him,  he  resigns  himself  as  patiently 
as  he  can  to  the  inevitable,  and  awaits  the  release  the  grim  monster 
of  the  hour-glass  and  scythe  brings.  The  essential  basic  element  of 
the  exercises  and  gymnastics  is  the  directing  of  them  purposely  by 
brain  action.  That  is  to  say,  these  movements  are  performed  with 
definite  purpose  and  intent,  the  attention  concentrated  upon  them, 
and  by  so  doing  the  sensori-motor  cortex  becomes  re-educated,  so 
that  the  movements  become  easier  and  easier  and  are  finally  performed 
without  conscious  attention  and  conscious  will  power.  Fraenkel  truly 
called  them  "cerebral  gymnastics."  These  movements  do  not  require 
force  and  power,  but  aim  at  acquiring  dexterity  and  skill,  and  each 
endeavor  must  be  marked  bv  methodical  and  exact  execution.     The 


356  PRACTICAL  HYDROTHERAPY. 

patient  usually  commences  with  the  simplest  of  movements,  and  as 
soon  as  these  can  be  done  well  and  accurately  moves  on  to  more 
complicated  ones.  Interest,  snap  and  closely  concentrated  attention 
should  mark  their  performance.  I  have  seen  patients  who  could  only 
walk  with  canes  and  crutches  much  benefited  and  able  to  lay  them 
aside  after  several  months'  exercise  in  combination  with  the  treatment 
above  outlined.  These  exercises  are  not  curative  of  locomotor 
ataxia,  as  many  seem  to  believe,  but  serve  to  overcome  the  ataxia. 
Contraindications  are  the  acute  cases  with  much  pain  and  crises, 
severe  arthropathy  and  fragile  bones,  and  markedly  run-down  and 
anemic  patients.  Successful  use  of  these  exercises  demands  much 
time  on  the  physician's  part,  a  careful  study  of  the  patient's  capacity, 
the  ability  to  enthuse  active  co-operation  and  a  thoroughly  trained 
assistant  and  gymnasium.  They  should  be  practiced  once  or  twice 
daily,  but  never  until  fatigued.  As  ataxia  of  the  lower  extremities 
is  much  more  marked,  so  it  is  much  more  difficult  in  overcoming  the 
upset  and  disordered  equilibrium.  I  have  selected  and  use  the  follow- 
ing exercises,  which  my  experience  has  taught  me  to  be  valuable,  and 
which  have  been  taken  from  the  plans  of  Fraenkel,  Goldscheider, 
Leyden,  Hirschberg,  Dana  and  others,  besides  a  few  of  my  own 
added. 

For  Hands  and  Arms. 

(a)  Sit  in  front  of  a  table,  place  hands  on  it,  elevate  fingers  sepa- 
rately, raise  hand  slightly,  extend  and  flex  each  finger. 

(b)  Hands  on  table,  spread  fingers,  contract  them. 

(c)  Dozen  pennies  on  table,  touch  each  one  slowly  with  forefinger 
of  each  hand. 

(  d)   Board  and  marbles,  put  marbles  in  holes. 
(e)   "Peg  board,"  put  pegs  in  holes  one  after  another. 
(/)    Swinging  balls  of  different  sizes,  oscillate,  and  while  moving 
seize  large  balls  first,  smaller  ones  last. 

For  the  Legs. 
(A)  Bed  Exercises  for  Legs.     Patient  Lying  on  His  Back  in  Bed. 

(a)  Flex  leg  on  abdomen  and  make  stepping  movement. 

(b)  Raise  leg  as  a  whole,  flex  and  extend  fully. 

(c)  Ladder  climbing,  making  accurate  climbing  and  stepping 
movements. 

(B)   Chair  Exercises. 

Raise  slowly  from  chair  without  aid  (as  soon  as  possible),  then 
sit  slowly. 

Sitting  in  chair,  flex  legs  and  make  stepping  movement. 

Raise  leg  as  a  whole,  flex,  then  extend  fully. 

"Pegging,"  first  touch  round  top  short  pegs,  then  flat  top  taller 
uprights. 


NERVES,  BRAIN  AND  SPINAL  CORD.  357 

(C)  Parallel  Bar  Exercises.  . 
Hold  to  bars  and  flex  legs. 

Hold  to  bars  and  walk  back  and  forth  and  sideways. 
Make  various  movements,  touching  spots,  drawing  circles,  etc. 
Obstacle  walking. 

Drill. 

(a)  Patients  walk  heel  and  toe,  body  erect,  soldierly  attitude,  a 
black  line  twelve  inches  wide. 

(b)  Same,  walking  line  six  inches  wide. 

(c)  Same,  walking  on  line  twelve  inches  wide  and  placing  foot 
exactly  on  large  white  transverse  lines,  thus  giving  soldier's  regula- 
tion step. 

(d)  Same  on  line  six  inches  wide. 

(e)  Side  stepping,  placing  feet  exactly,  first  on  small  transverse 
lines,  then  on  larger. 

(/)  Side  stepping,  placing  alternately  right  and  left  foot  exactly 
in  painted  footprints. 

(g)  Foot  on  center  dot,  drawing  circles  with  alternate  limbs,  es- 
pecially toes. 

(h)  Walking  zigzag  lines,  turning  promptly  and  returning  to 
starting  point. 

(i)   "Right  face''  exercise,  keeping  on  footprints. 

(/)   "Left  face"  exercise,  keeping  on  footprints. 

(k)  "Setting  up"  movement  (useful  and  difficult)  ;  raise  legs  as 
high  as  possible,  flex  same,  bringing  toe  down  on  large  transverse 
white  line,  using  alternate  legs  and  progressing  along  the  line. 

(/)   Stand  feet  wide  apart. 

(w)  Stand  feet  together,  count  twenty;  increase  until  one  hundred 
is  reached. 

(«)  Advance  one  foot  the  length  of  small  transverse  white  line, 
bring  other  up. 

(o)   Balance  on  one  foot. 

(p)  Obstacle  walking  (over  different  things  placed  on  the  floor, 
blocks  of  wood). 

(q)   Stair  climbing. 

(r)  Stand  with  feet  apart,  hands  on  hips,  flex  limbs,  stoop  as  low 
as  possible,  rise  slowly. 

(s)   Walk  backward  along  lines. 

(t)  Feet  apart;  raise  arms  from  side  until  they  meet  above  head; 
carry  them  forward  and  downward,  bending  the  body  until  the  tips  of 
the  fingers  come  near  the  floor. 

(w)   Feet  apart;  hands  on  hip,  make  circle  with  head. 

The  author  offers  herewith  a  schedule  or  plan  of  treatment  which 
has  proved  in  his  hands  very  efficacious,  and  which,  in  conjunction 
with  hydrotherapy,  should  lead  to  most  excellent  results : 


358  PRACTICAL  HYDROTHERAPY. 

First  Stage. — Sanatorium  treatment.  Rest  in  bed  till  late  in  the 
morning. 

9 — 10  a.m.  Mechanical  massage,  followed  by  rest  until  middle  of 
day,  either  in  bed,  on  sofa  or  in  chair. 

1 — 2  p  m.  Hydrotherapy  as  per  forms  suggested,  followed  by 
rest. 

3 — 4-  p.m.  General  faradism  and  exercise  of  muscles,  or  galvanism 
to  spine. 

7 — 8  p.m.  Static  electricity,  abundant  diet,  laxatives  as  needed, 
iron,  quinine  and  strychnine  tonic. 

Second  Stage. — Gradually  allow  patient  to  get  up,  remaining  up 
longer  each  day;  add  exercises  gradually. 

Rest  in  bed  until  after  breakfast.     Massage  mechanical,  heavy. 

Hydrotherapy  at  midday,  exercises  in  afternoon,  static  and  gal- 
vanic at  night  (one  or  the  other). 

Third  Stage. — Up.  going  about,  attending  to  business.  During 
week  take  exercises  morning  and  night,  or  at  sanatorium. 

Daily  tieatment  at  sanatorium:  Mechanical  massage  followed  by 
static  electricity  three  times  weekly;  galvanic  three  times  weekly,  or 
mechanical  massage  followed  by  static  electricity  twice  weekly;  half 
bath  twice  weekly;  galvanic  twice  weekly. 

There  is  no  question  but  what  a  stay  in  a  hospital  or  sanatorium 
benefits  these  cases  more  than  any  form  of  treatment,  this  being  often- 
times shown  in  cases  that  seek  public  hospitals,  where  the  diet  is 
meager,  the  milk  thin,  and  conditions,  if  anything,  unfavorable.  The 
value  of  hydrotherapy  lies  principally  in  its  marked  ability  to  improve 
nutrition. 

The  disease  cannot  be  treated  by  the  general  practitioner  owing  to 
lack  of  apparatus  and  time. 

Cases  must  not  be  considered  hopeless ;  even  the  most  severe  can 
be  helped. 

The  treatment  must  be  persisted  in,  not  for  weeks,  but  for  months. 

The  sooner  a  tabetic  becomes  a  philosopher  about  his  disease  and 
determines  to  earn  relief,  benefit  and  symptomatic  cure,  the  better 
for  him. 

Until  recovery  has  taken  place  the  physician  must  exercise  close 
supervision  over  the  case ;  relaxation  of  treatment  is  nearly  always 
followed  by  relapse  or  retrogession. 

Even  where  the  ataxia  is  so  great  as  to  require  support  in  walking, 
or  when  locomotion  is  almost  impossible,  most  helpful  results  may  be 
obtained.  I  have  cases  that  walk  so  well  that  no  one  could  detect 
anything     amiss. 

A  gain  in  weight,  strength,  nerve  force  and  blood,  together  with  a 
relief  of  the  more  or  less  neurasthenia  and  phobia  that  accompany 
the  disease,  may  be  counted  upon. 


NERVES,  BRAIN  AND  SPINAL  CORD.  359 

Patients  will  also  gain  hope,  courage  and  become  much  more 
content  and  happy,  to  say  nothing  of  the  comfort  that  return  to 
business   and   work   insures. 

Where  patients  are  put  to  bed,  the  plan  must  be  followed  until 
they  gain  in  blood  count,  flesh  and  strength. 

Improvement  under  this  system  is  usually  felt  from  the  first,  and 
varies  in  its  rapidity,  being  dependent  upon  the  intelligence,  patience 
and  persistence  of  the  patient,  his  general  health  and  the  stage  of  the 
disease.  The  results  of  exercise  and  treatment  are  permanent  if 
general  health  remains  good.  Cases  of  slow  progress  toward  recovery 
are  the  best,  as  they  tend  less  toward  relapse,  pains,  etc. 

False  hopes  of  speedy  cure  should  not  be  held  out  to  the  patient, 
but  he  should  be  made  to  plainly  understand  that,  while  his  disease 
is  a  very  grave  one,  he  is  not  a  hopeless  sufferer;  that  by  patient, 
steady  and  conscientious  work  on  his  part,  constant  supervision,  direc- 
tion and  guidance  on  his  physician's  part,  relief  from  suffering, 
amelioration  of  symptoms  and  arrest  of  the  disease  will  ensue. 
There  are,  in  my  opinion,  no  class  of  sufferers  so  appreciative  of 
relief  as  those  now  under  consideration,  and  sympathy,  patience, 
kindness  and  the  best  efforts  of  the  physician  should  be  directed 
toward  sustaining  them  in  the  hour  of  their  affliction.  They  should 
be  imbued  with  that  fortitude,  patience  and  strength  that  are  the 
best  attributes  of  humanity,  while  receiving  the  most  advanced  and 
scientific  treatment  that  the  profession  can  afford. 

The  above  treatment  outlined  for  locomotor  ataxia  is  a  type  of 
treatment  suitable  for  all  the  diseases  considered  in  this  group. 

Spastic  spinal  paralysis  is  believed  to  be  of  congenital  origin,  due 
to  lack  of  development  of  the  lateral  pyramidal  tracts  in  the  spinal 
cord,  tending  to  the  production  of  sclerosis  of  these  columns,  accom- 
panied by  rigidity  of  the  legs  and  arms,  exaggeration  of  the  reflexes, 
and  some  muscular  weakness.  Other  cases  are  simply  a  form  of 
paraplegia  caused  by  a  previous  myelitis. 

Ataxic  paraplegia  (Gowers)  is  an  accidental  form  of  these  scle- 
roses, affecting  both  the  posterior  and  lateral  columns  of  the  spinal 
cord,  forming  part  of  what  Dana  calls  "the  combined  scleroses,"  which 
should  be  classed  either  with  locomotor  ataxia,  chronic  myelitis  or 
multiple  sclerosis. 

Fncdnch's  ataxia,  die  most  common  of  the  hereditary  ataxias, 
is  due  to  an  hereditary  lack  of  development  in  the  posterior  and  lat- 
eral columns  of  the  spinal  cord;  is  characterized  by  ataxia  beginning 
in  the  lower  limbs,  spreading  to  the  other  extremities,  with  absence 
of  the  knee  jerk,  no  pain,  anesthesia  or  optic  atrophy,  and  finally  ter- 
minating with  contractures.  There  is  a  flattening  of  the  cord,  a  scle- 
rosis of  the  lateral  and  posterior  columns  and  the  posterior  nerve 
roots,  with  some  degeneration  of  the  peripheral  nerves. 


360  PRACTICAL  HYDROTHERAPY. 

Multiple  sclerosis  is  a  chronic  degenerative  disease,  to  a  certain 
extent  progressive,  interrupted  by  remissions,  and  characterized  by 
paralysis,  intention  tremor,  nystagmus,  syllabic  disturbances  of  speech, 
and  certain  localized  symptoms,  depending  upon  the  situation  of  the 
plaques  of  sclerosis.  It  is  a  disease  of  early  life,  more  frequent  in 
males,  and  nearly  always  follows  infectious  diseases ;  in  fact,  Dana 
states  that  it  may  be  called  a  post-infectious  disease.  Xodules  of 
sclerosis  most  frequently  occur  in  the  white  matter,  and  consist  of 
fibrous  tissue  with  neuraxons  passing  through  the  sclerosed  area. 
The  blood-vessels  are  thickened,  and  there  is  increased  vascularity. 
It  destroys  the  myelin  sheaths  of  the  nerve  fibers,  the  neuraxons  re- 
maining intact  for  a  long  time  and  conducting  impulses. 


CHAPTER  XVIII. 
FUNCTIONAL  NERVOUS  DISEASES. 

Neurasthenia;  Spinal  Irritation;  Nervous  Dyspepsia. 

The  struggle  for  existence  in  America  to-day  has  resulted  in  in- 
fusing into  existence  an  intensity  of  life  to  which  the  nation  had 
been  a  stranger  until  the  present  epoch  was  reached.  A  great  deal 
of  this  can  be  attributed  to  the  value  attached  to  money  and  all  the 
pleasures,  benefits  and  emoluments  that  come  with  its  possession. 
The  strain  and  worry  of  business,  the  growth  of  social  aspirations, 
disappointments  and  hollowness  of  this  life,  the  nerve-racking  activity 
of  the  daily  press,  with  its  sensational  gossip,  ghastly  and  sickening 
details  of  crime,  murder,  defalcation  and  suicide  and  political  bick- 
erings, form  a  constant  nerve-racking  state.  The  wonderful  devel- 
opment of  electricity,  turning  night  into  day;  rapid  transit,  with  all 
it  means;  the  organization  of  enormous  corporations  or  "trusts"  that 
throttle  competition,  render  men  occupationless  and  homeless,  and 
the  increasing  and  countless  numbers  of  victims,  the  results  of  acci- 
dents, have  even  developed  special  forms  of  this  disease.  The  drift 
of  population  towards  cities,  with  their  noisy  life;  living  in  poorly 
ventilated  and  improperly  lighted  rooms,  obtaining  little  sunlight  and 
fresh  air,  while  laboring  under  an  intense  pressure,  is  robbing  the 
country  of  many  of  its  best  specimens  of  vigorous  nerve  force. 

Neurasthenia  is  a  chronic  nervous  functional  disorder  characterized 
by  nervous  weakness  and  irritability,  a  neurosis  without  organic  basis 
(  ?),  dependent  upon  nutritional  change  in  the  neuron,  as  a  resultant  of 
which  neural  energy  is  no  longer  properly  stored  or  emitted.  Men 
are  more  often  affected  than  women.  It  occurs  more  frequently  in 
the  married,  due  to  the  heavy  entailments  of  this  life,  with  its  many 
burdens  and  responsibilities.  Neurasthenia  is  more  a  disease  of  the 
cultivated,  high-strung,  and  of  those  who  have  reached  years  of  fullest 
maturity.  Indoor  workers  and  the  Hebrew  are  especially  prone  to 
succumb.  It  occurs  more  frequently  in  the  city  than  in  the  country, 
though  it  is  increasing  in  the  rural  population,  due  to  their  closer 
and  more  intimate  connection  with  the  outside  world.  Heredity 
plays  some  part,  in  that  neuroses  in  parents  are  apt  to  develop  in  their 
offspring  over-sensitive  nerve  organization.  The  most  important  ex- 
citing cause  is  overwork,  accompanied  by  mental  worry,  strain,  sor- 
row, fright,  etc.,  especially  in  those  who  are  untrained  and  unpre- 
(361) 


362  PRACTICAL  HYDROTHERAPY. 

pared  for  work.  Young  men  who  over-study,  who  are  working  their 
way  through  college  and  profession  under  great  disadvantages,  fre- 
quently break  down,  as  do  young  women  who  over-work,  over-study 
and  "do  society."  Traumatic  conditions  brought  about  by  the  fright 
and  shock  incident  to  serious  injuries,  or  exposure  to  danger  by  acci- 
dents occurring  during  travel  upon  great  transportation  lines,  have 
developed  the  "traumatic  neuroses."  Poisons  of  acute  infectious  dis- 
ease, especially  influenza,  with  its  selective  action  upon  the  nervous 
system,  are  prone  to  leave  in  their  wake  many  neurasthenics.  The 
worry  of  syphilis,  the  wearing  effects  of  anti-syphilitic  treatment  and 
excessive  alcoholism  produce  serious  forms  of  the  disorder.  Lith- 
emia  and  other  manifestations  of  the  gouty  and  rheumatic  states  are 
no  longer  given  prominence  as  causes  in  producing  this  disorder,  but 
they  follow  in  the  same  category  as  do  eye-strain,  middle-ear  and 
pelvic  diseases,  acting  only  as  agents  when  they  have  a  neurotic  basis 
upon  which  to  build.  Auto-toxemia  with  gastro-intestinal  atony  is, 
in  the  author's  opinion,  more  often  the  result  of  the  neurasthenia 
than  a  cause,  but  when  once  engendered  acts  in  maintaining  the  con- 
dition and  adds  to  the  vicious  cycle.  Neurasthenics  produce  little 
nervous  energy,  discharge  same  easily  and  recharge  their  neurons 
poorly.  Dana  truly  sums  up  the  whole  situation  by  saving  the  causes 
are  bad  heredity  and  foolish  living. 

These  cases  complain  of  intense  mental  depression,  incapacity  for 
mental  work,  lack  of  concentration,  mental  irritability,  impaired  mem- 
ory, lack  of  will  power  and  capacity,  mental  confusion,  easily  ex- 
cited emotions,  morbid  fears  and  dreads,  cephalic  paresthesia  of  bands, 
pressure,  weights,  etc. ;  insomnia,  headache,  vertigo,  intense  physical 
weariness,  indefinable  pains,  palpitations,  pulsations,  flushes,  cold  ex- 
tremities ;  lack  of  appetite,  indigestion,  constipation,  sexual  irritability, 
weakness ;  their  reflexes  are  exaggerated,  flesh  is  lost ;  there  is  a  fine 
tremor ;  the  pulse  is  small,  rapid,  high  tension,  pupils  dilated ;  anemia 
is  present,  and  the  urine,  of  varying  specific  gravity,  contains  oxalates, 
and  at  times  urates,  indican,  excess  of  phosphates,  and  sometimes  a 
transient  glycosuria. 

The  pathology,  as  shown  by  Hodge,  is  that  of  exhaustion,  charac- 
terized by  a  neuron  body  of  which  the  nucleus  is  decreased  in  size, 
with  irregular  jagged  outline,  its  protoplasm  being  shrunken.  Asso- 
ciated with  these  changes  are  improper  and  irregular  distribution  of 
the  blood,  due  to  involvement  of  the  vasomotor  system,  thus  ma- 
terially impairing  the  nutrition  and  functionating  capacity  of  the  neu- 
ron bodies. 

"Complete  restoration  to  health  is  possible  and  frequent,  but  a 
patient  has  to  take  more  care  of  himself  than  before.  As  a  result  of 
an  attack  of  neurasthenia,  men  and  women  who  have  suffered  from 
it  are  apt  thereafter  to  lead  very  saint-like  and  ascetic  lives,  and  hence, 


Fl  WCT/oX.  \L  NERl  'OUS  DISEASES.  363 

as  a  rule,  live  long.  It  used  to  be  said  by  1  h.  Beard  that  neurasthenics 
would  have  a  long  and  happy  old  age.  They  pass  through  the  Valley 
of  the  Shadow  of  Death,  hut  the  experience  may  be  a  profitable  one, 
even  though  it  is  not  a  pleasant  one."'  ' 

The  treatment  of  the  attack  of  neurasthenia  requires  a  good  know- 
ledge of  human  nature  and  an  unlimited  fund  of  patience.  The  writer 
is  constrained  to  believe  that  this  is  much  more  necessary  than  a  know- 
ledge of  the  physiological  action  of  drugs.  The  physician  who  treats 
these  cases  must  he  so  situated  as  to  have  time,  inclination  and  facil- 
ities at  command,  and  if  he  has  not  he  should  be  honest  enough  with 
his  patient  to  refuse  to  handle  his  case,  and  send  him  elsewhere.  Hand 
in  hand  with  the  physical  and  bodily  treatment  must  he  found  mental 
therapy.  Kind  and  careful  consideration,  tact,  justice  tempered  by 
kindness,  thoughtfulness,  should  be  so  intermingled  as  to  gain  their 
confidence  and  complete  docility  to  authority.  This  comes  only  with 
the  long  training  incident  to  the  work  of  the  successful  specialist. 
He  may  add  to  the  store  of  his  power  by  the  use  of  physical  measures 
that  relieve  the  intensity  of  present  symptoms.  These  agents  are 
alone  capable  of  relieving  the  disorder,  but  backed  by  the  tactful  phy- 
sician become  agents  for  powerful  good.  Neurasthenics  must  be  en- 
couraged and  assured  that  they  have  no  incurable  disease,  no  organic 
trouble,  and  this  must  be  told  to  them  repeatedly.  Individualization, 
kindness,  perseverance,  patience  and  constant  striving  will  go  a  long 
distance,  for  the  symptoms  from  which  these  patients  suffer  are  not 
imaginary,  but  real.  Careful  examination,  diagnosis,  methodical  care 
and  attention  to  detail  are  indispensable. 

In  severe  cases,  those  that  are  badly  in  need  of  fat  and  blood, 
who  are  sadly  anemic,  should  be  isolated  from  home  and  sympathetic 
friends,  who  suggest  many  things  to  be  done  and  continually  question 
symptoms  and  conditions.  The  isolation  should  be  complete  in  these 
cases.  It  may  be  said  that  isolation  in  a  small  infirmary  devoted  to 
nervous  disease,  under  the  personal  care  and  attention  of  a  physician 
whose  personnel  will  go  a  long  distance,  who  has  at  his  command 
every  facility,  offers  the  ideal  treatment.  Isolation  breaks  up  inju- 
rious excitement,  pernicious  habits,  queer  beliefs,  and  in  these  cases 
should  be  carried  out  regardless  of  peculiarities  and  temperament. 
As  soon  as  isolation  has  been  secured  and  full  treatment  instituted 
the  patient  gains  courage  from  the  mere  fact  that  some  systematic 
method  is  being  followed,  and  this  "cheers  him  up."  In  passing  it 
may  be  stated  that  persons  in  good  circumstances  recover  more  fre- 
quently, because  they  can  take  the  treatment  as  is  should  be  given. 
In  other  cases,  those  who  are  up  and  about  and  who  need  exercise 
and  diversion,  we  may  institute  a  partial  rest  cure — early  to  bed  and 
late  to  rise,  with  rest  after  treatment  and  after  dinner.     These  cases 

1    Dana,   C.    L. :    "Text-Book  of  Nervous   Diseases,"    1897,  p.   295. 


364  PRACTICAL  HYDROTHERAPY. 

can  sometimes  follow  out  the  treatment  at  home  by  giving  up  a  part 
of  their  occupation  and  duties. 

The  diet  should  be  full,  nutritious,  and  to  the  extent  of  toleration. 
Unless  some  gastric  lesion  is  present  neurasthenics  must  be  urged  to 
satisfy  their  appetite.  They  should  drink  water  freely  unless  arterio- 
sclerosis or  cirrhotic  kidney  is  present.  Mineral  waters,  especially 
lithiated  ones,  are  of  no  value — a  farce  other  than  the  water  they 
contain.  Patients  should  ignore  some  of  the  temporary  discomforts 
located  in  the  stomach  and  eat  freely.  These  cases  are  often  "stom- 
ach-tube fiends,"  washing  their  stomachs  upon  the  slightest  provoca- 
tion. Stomach-washing  should  be  done  by  the  physician  himself,  and 
only  when  extreme  fermentation  or  catarrh  is  present.  A  mixed  diet 
is  best,  with  meat  once  a  day,  preferably  at  dinner,  although  a  few 
pieces  of  crisp  bacon  may  be  allowed  at  breakfast.  Fish  and  eggs 
form  excellent  articles  of  diet.  Cereals,  such  as  rice,  sago,  cracked 
wheat,  rolled  oats,  shredded  whole  wheat;  green  vegetables,  spinach, 
green  and  string  beans,  celery,  lettuce,  cresses ;  purees  of  peas,  beans, 
potatoes;  fruits,  cooked  and  raw;  butter  freely  if  it  does  not  take 
away  the  appetite;  bread  and  beaten  biscuits,  toast,  crackers,  whole 
wheat,  zwieback.  They  may  drink  water,  milk,  cream,  to  which  plas- 
mon  may  be  added;  milk  and  plasmon  may  be  taken  after  treatment, 
and  as  a  variant  cream  toast.  Stimulants  I  do  not  believe  in,  and  in- 
terdict theii  use.  Sometimes  malt  extracts  may  be  prescribed  with 
meals,  but  of  these  I  have  my  doubts.  Coffee  at  breakfast  and  an 
occasional  cigar  are  latitudes  that  may  be  indulged.  Alcoholic  prepa- 
rations interfere  seriously  with  digestion. 

Rest  is  an  essential  feature  of  the  treatment.  Climate  is  not  cura- 
tive, the  best  being  a  warm  and  equable  one  that  permits  of  outdoor 
exercise  and  entertainment.  Climatic  changes  are  often  given  the 
credit  of  curing,  when  rest,  freedom  from  business  cares  and  worry 
have  done  the  work.  Camping  out  in  the  woods  is  a  good 
method.  In  winter  the  Riviera,  Mediterranean,  Bermuda  and  North 
Carolina ;  in  summer,  Michigan  and  Maine  are  excellent  health  resorts. 
Travel  is  useless  in  these  cases.  My  'experience  has  been  that  climate 
fills  its  best  function  as  an  aftermath  rather  than  as  a  method  of 
cure.  Drugs  per  se  are  valueless,  none  being  known  that  create 
"nerve  force."  Too  great  condemnation  cannot  be  heaped  upon  tes- 
ticular juice,  animal  extracts,  be  they  of  the  goat,  sheep,  ox,  pure 
or  impure ;  nor  have  they  added  one  whit  to  the  therapy  of  this  dis- 
ease. Oftentimes  it  is  necessary  to  forbid  medicines,  the  best  of 
which  are  digestants,  bitter  tonics,  and  in  anemia,  Blaud's  mass  with 
arsenic.  Hypnotics  in  small  doses  at  the  start  assist  hydrotherapy. 
Local  treatment  to  cure  neurasthenia  is  a  farce,  no  matter  whether 
this  be  applied  to  the  eye  muscles,  uterus,  prostate,  stomach,  etc.  In 
the    general    plan    of    treatment    we    should    relieve    these    infirmi- 


FUNCTIONAL  NERVOUS  DISEASES.  365 

ties,  because  by  so  doing  we  are  lightening  tbe  load  to  the  weary 
animal. 

Hydrotherapy  is  by  far  the  most  important  of  all  the  physical 
measures  used  in  the  treatment  of  neurasthenia.  An  experience  of 
nearly  two  decades  has  taught  the  author  the  value  of  this  agent,  and 
limited  to  one  method  alone  for  this  disease  he  would  unquestionably 
choose  hydriatic  measures.  All  treatment  instituted  for  the  relief 
and  cure  of  the  neurasthenic  must  be  persisted  in  not  for  a  day  or 
week,  but  oftentimes  for  many  weeks  and  even  months.  This  is  true 
of  hydrotherapy,  and  in  its  application  it  should  always  be  borne  in 
mind  that  the  patient  must  be  carefully  studied  and  his  reaction  de- 
veloped. It  is  the  author's  opinion  that  neurasthenics  should  always 
be  sent  to  a  hydriatic  institution,  owing  to  the  needs  of  complex  appa- 
ratus by  means  of  which  the  various  forms  of  douche  are  adminis- 
tered, and  to  the  further  fact  that  those  engaged  in  this  work  acquire 
an  experience  and  knowledge  that  enable  them  to  meet  the  problems 
that  arise  in  every  case  of  this  disorder. 

The  treatment  should  be  daily,  with  Sunday  excepted,  both  on 
account  of  the  advantage  that  comes  from  intermission  in  treatment 
as  well  as  for  moral  and  ethical  reasons.  In  women  suffering  from 
this  disorder  it  should  be  borne  in  mind  that  they  have  to  be  slowly 
trained  to  hydriatic  treatment,  their  reaction,  as  a  rule,  being  less 
prompt  and  less  vigorous  than  that  of  men.  Hydrotherapy  makes  a 
powerful  appeal  to  the  body  and  mind,  by  stimulating  the  deeper  and 
superficial  circulation ;  it  acts  upon  the  peripheral  nerves,  arousing 
them  to  healthy  action,  and  by  thousands  of  reflexes  influences  brain 
and  spinal  cord,  producing  tonic  and  sedative  effects  absolutely  un- 
equaled.  A  feeling  or  sense  of  well-being  follows  reaction,  giving 
confidence  to  the  patient.  It  stimulates  muscular  action  and  increases 
its  power,  removes  many  paresthesias,  increases  appetite  and  digestion 
and  favors  changes  in  metabolism. 

A  plan  suitable  for  the  home  or  for  those  whose  reaction  is  poor 
would  be  the  following:  Dry  pack  for  one-half  to  one  hour,  followed 
by  a  cold  sponge  with  water  at  a  temperature  of  70°  F.  After  a  few 
days  of  this  treatment  give  the  full  dry  pack  for  thirty  minutes,  fol- 
lowed by  the  dripping  sheet  at  70°  F.  for  three  minutes,  with  vigorous 
friction.  As  soon  as  this  point  is  reached  dispense  with  the  dry  pack 
and  give  the  dripping  sheet  at  65°  F.  for  three  minutes,  with  good 
friction,  while  the  patient  stands  in  a  foot-tub  of  water  as  hot  as  can 
be  borne.  Reaction  must  be  secured.  This  treatment  is  generally 
administered  in  the  morning,  and  when  this  time  is  selected  give  the 
general  wet  pack  at  65°  F.  for  one  hour  at  bedtime.  When  the  pa- 
tient is  removed  from  the  pack  he  is  rapidly  dried  and  no  reaction  is 
sought.  The  advantage  of  this  method  of  treatment  is  to  obtain  the 
stimulating  and  tonic  influences  of  the  dripping  sheet  in  the  morning 


366  PRACTICAL  HYDROTHERAPY. 

and  the  sedative  and  sleep-producing  effects  of  the  wet  pack  at  bed- 
time. 

Another  good  method  is  to  have  the  patient  sit  in  a  half  bath  with 
water  at  102°  to  104°  F.,  while  the  attendant  gives  him  an  affusion  at 
80°  F.  to  the  spine,  back  and  chest.  Reduce  temperature  five  degrees 
daily  to  65°  F.  At  this  point  the  patient  should  stand  in  the  tub  in 
water  as  hot  as  can  be  borne  while  the  affusion  is  given  to  the  entire 
body,  or  the  water  is  thrown  with  force  against  the  body  from  a  large 
dipper.  This  may  be  further  modified  by  first  immersing  the  body 
in  warm  water,  then  giving  a  salt  rub  or  glow,  followed  by  the  affu- 
sion. The  warm  full  bath  (104°  to  105°  F.)  for  five  or  seven  min- 
utes, followed  by  the  salt  rub,  and  finally  by  the  cold  shower  at  70° 
to  65°  F.,  will  be  found  useful.     Reaction  is  essential 

In  institutions  or  sanatoria  many  women  and  nearly  all  men  may 
commence  with  the  following,  particularly  if  the  case  is  up  and  going 
about :  Electric  light  bath  or  hot-air  bath  until  perspiration  commences, 
followed  by  the  circular  or  horizontal  rain  bath  at  100°  to  104°  F. 
for  one  ana  one-half  to  two  minutes,  reduced  to  75°  F.  for  one-fourth 
minute,  with  a  pressure  of  twenty  pounds.  Reduce  the  temperature 
two  degrees  daily  to  60°  F.  and  increase  the  pressure  two  pounds 
daily  until  thirty  is  registered.  After  about  a  week  of  this  treatment 
we  may  add  to  the  above  the  fan  douche  at  a  temperature  of  69° 
F.  to  the  entire  body  for  five  to  ten  seconds.  The  next  move  should 
be  the  following:  Electric  light  or  hot  air  bath  until  perspiration  takes 
place,  followed  by  the  horizontal  or  circular  rain  bath  at  100°  to  104° 
F.  for  one  minute,  reduced  to  60°  F.  for  fifteen  to  twenty  seconds, 
pressure  thirty  pounds,  to  be  followed  by  the  jet  douche  to  the  spine 
and  legs  at  60°  F.  for  five  seconds.  An  excellent  method  of  treating 
these  cases  after  reaction  has  been  well  established  is  to  apply  the 
jet  douche  to  the  spine  at  a  temperature  of  105°  F.  for  a  half  to  one 
minute,  followed  by  the  jet  to  the  spine  at  a  temperature  of  60°  F. 
for  ten  seconds,  increasing  the  temperature  of  the  hot  water  two  de- 
grees dad)-  until- 110°  or  even  120°  F.  is  reached,  at  which  point  it 
will  usually  be  found  the  patient  can  tolerate  no  higher  temperature. 
This  is  especially  useful  in  men  who  are  physically  strong  and  who 
complain  of  persistent  "head  feelings"  and  tender  spine.  Neuras- 
thenics do  not,  as  a  rule,  stand  the  Scottish  douche  well.  Certain 
prominent   symptoms   oftentimes   demand   special   attention. 

The  incomnia  can  best  be  met  by  the  cold  wet  pack  or  dripping 
sheet  at  bedtime,  or  the  so-called  "Neptune's  girdle,"  or  trunk  com- 
press, consisting  of  a  coarse  linen  bandage  wrung  out  of  water  at  a 
temperature  of  65°  F.  and  covered  by  several  layers  of  the  same  ma- 
terial to  exclude  the  air.  It  should  be  worn  all  night.  A  most  ex- 
cellent method  is  the  neutral  bath,  temperature  94°  to  96°  F.,  for 
twenty   to   sixty  minutes.      Simple  measures  that  sometimes   produce 


FUNCTIONAL  NERVOUS  DISEASES.  367 

sleep  are  the  use  of  Chapman's  ice-bag  to  the  spine,  or  a  hot  and  cold 
spinal  sponge.  In  addition,  we  may  give  six  to  twelve  ounces  of  warm 
milk  on  retiring,  either  plain  or  predigested. 

For  headaches  and  head  pressure,  the  fomentation  applied  for  five 
or  ten  minutes  twice,  and  followed  by  a  cold  compress,  is  very  ef- 
fective. If  the  headache  is  congestive,  use  the  hot  foot-bath,  fol- 
lowed by  the  ice-bag  to  the  nape  of  the  neck  and  the  cold  compress 
to  the  forehead.  If  it  is  a  sick  headache  (see  Migraine),  wash  out 
the  stomach,  administering  a  saline  purgative  through  the  tube,  giving 
a  hot  foot-bath,  followed  by  the  cold  compress  to  the  forehead.  If 
the  headache  is  persistent,  indefinable  and  annoying,  it  can  sometimes 
be  permanently  relieved  by  means  of  the  Scottish  or  alternate  douche 
to  the  spine  and  legs. 

"Spina!  irritation,''  so-called,  or  the  "neurasthenic  spine,"  is  best 
met  by  general  douche  treatment  to  the  spine.  Where  this  is  not  ef- 
fective, use  the  Scottish  douche  at  120°  to  125°  F.  for  thirty  seconds, 
followed  b)  a  temperature  of  50°  to  60°  F.  for  five  to  ten  seconds,  with 
four  alternations.  Sometimes  the  hot  and  cold  spinal  sponge  at  bed- 
time is  successful. 

For  eye  pains  and  muscac  volitantes,  the  fomentation  to  the  eyes 
and  forehead,  followed  by  the  cold  compress  for  half  an  hour,  re- 
peated, if  necessary,  several  times  daily. 

For  ovarian  irritation  and  vaginal  discharges,  use  hot  vaginal  irri- 
gation daily,  or  twice  daily,  and  the  hot  trunk  pack  applied  sufficiently 
low  down  to  include  the  pelvis  and  hips— that  is  to  say,  to  the  middle 
of  the  thighs. 

For  anorexia,  a  glass  of  ice-water  one  hour  and  the  ice-bag  for 
half  an  hour  before  meals.  It  is  astonishing  sometimes  what  results 
will  follow  this  timple  treatment. 

Mental  depression  is  best  met  by  general  measures,  though  the 
neutral  bath  at  bedtime  sometimes  proves  very  satisfactory. 

For  dyspepsia  nervosa  the  patient  must  be  placed  upon  the  general 
treatment,  although  the  trunk  pack  at  a  temperature  of  65°  F.  for  one 
hour  is  sometimes  helpful. 

Prophylaxis  and  the  maintenance  of  health  after  recovery  are  best 
secured  by  a  combination  of  factors,  of  which  hydrotherapy  is  the 
most  important.  The  individual  should  strive  to  lessen,  as  far  as  pos- 
sible, his  struggle  for  existence,  and  at  the  same  time  by  perseverance 
and  practice  overcome  his  tendency  to  work.  This  is  possible  if  the 
patient  is  heartily  in  earnest  and  fully  appreciative  of  its  necessity. 
He  must  fortify  his  neural  energy  at  all  times,  especially  those  who 
have  a  bad  hereditary  basis.  Those  who  have  had  an  attack  of  neuras- 
thenia may  engage  in  mental  and  physical  work  freely  if  they  learn 
to  free  their  labor  or  occupation  from  anxiety,  worry  and  fretting. 
Neurasthenics  should  carefully  watch  their  sleep,  and  if  at  any  time  this 


368  PRACTICAL  HYDROTHERAPY. 

is  becoming  interrupted  or  disordered  they  should  at  once  seek  the 
advice  and  counsel  of  their  medical  adviser,  and  in  this  way  the  phy- 
sician can  occupy  a  most  important  domain  in  the  prevention  of  a 
recurrence  of  the  attack.  The  author  has  under  his  care  at  the  pres- 
ent time  a  number  of  cases  who  report  to  him  when  the  stress  of 
their  life  or  the  strain  of  their  business  becomes  unusual.  They  have 
learned  that  by  such  care  they  secure  freedom  and  immunity  from 
suffering,  and  it  is  his  practice  in  these  cases,  should  the  condition  de- 
mand, to  institute  a  short  course  of  hydrotherapy,  which  promptly 
relieves  thp  symptoms  and  restores  function.  Among  those  conditions 
that  demand  immediate  and  proper  attention  are  disorders  of  diges- 
tion ;  under  no  circumstances  should  they  be  permitted  to  continue, 
nor  should  the  patient  attempt  self-treatment  or  medication.  The 
prevention  of  neurasthenia  and  the  maintenance  of  health  can,  as  a 
rule,  be  cared  for  without  interruption  or  loss  of  time  from  business, 
merely  a  temporary  reduction  of  labor  and  the  institution  of  short 
courses  of  treatment.  Children  should  be  brought  up  with  the  idea 
in  view  that  they  are  to  enter  a  life  in  which  it  is  likely  they  will  be 
subjected  to  the  possibility  of  an  attack  of  neurasthenia,  and  this 
becomes  of  double  importance  when  we  consider  the  number  of  chil- 
dren who  are  born  neurotic,  or  who  inherit,  to  say  the  least,  sensitive 
nerves.  These  children  should  be  educated  and  prepared  along  lines 
that  will  prevent  the  occurrence  of  this  disease,  and  which  will  be 
found  under  a  separate  heading.  (See  ''Rearing  of  the  Xeurotic 
Child.")  Exercise  is  an  excellent  means  of  preserving  health,  and  to 
this  end  I  advise  the  use  of  the  bicycle  and  golf.  In  conclusion,  it 
may  be  said  that  there  are  a  number  of  conditions  resembling  neu- 
rasthenia— that  is  to  say.  neurasthenoid — which  yield  to  the  same 
treatment,  though  much  more  rapidly  than  true  neural  exhaustion. 

Hysteria. 

The  modern  conception  of  hysteria  is  that  of  a  psycho-neurosis, 
the  underlying  stratum  or  background  of  which  is  a  profound  neuro- 
psycopathic  inheritance,  the  most  important  exciting  cause  being 
psychic  trauma.  The  many  diverse  s}mptoms  from  which  these  cases 
suffer  have  caused  the  name  "protean"  to  be  applied  to  its  symptoms. 
It  is  essentially  a  psychosis,  due  to  pathological  conditions  as  yet  un- 
known, although  probably  a  definite  one,  and  characterized  by  hys- 
terical attacks  or  '"crises"  and  an  interparoxysmal  period.  Specialists 
restrict  the  term  to  the  definite  manifestations  of  the  disorder,  and 
do  not  loosely  apply  it  to  all  peculiar  forms  of  nervous  manifestation. 
It  is  not  a  disease  limited  to  the  female,  nor  associated  with  her  or- 
gans of  reproduction,  as  was  once  believed,  but  occurs  in  men  with 
considerable  frequency,  and  occasionally  in  children.  My  experience  has 
been  that  the  most  severe  cases  have  been  in  men,  due  to  traumatic 


FUNCTIONAL  NERVOUS  DISEASES.  369 

causes.     W«   do  not  see  in  America  the  severe  cases  that  are  of  such 
common  occurrence  m  the  French  and  Latin  nations,  nor  have  I  seen 
any  case  in  my  private  experience  equal  to  the  ones  lectured  upon  by 
Professor   Charcot   at    the   Salpetriere.      We,    fortunately,   have    the 
milder   forms  of  the  disease.     Race  predisposes,  and  in  this  respect 
the    Hebrew    furnishes   the  largest   contingent.      I   have   seen   quite   a 
number  among  Polish  Jews.     The  disease  is  one  of  early  adult  life, 
and  occurs  most  frequently  among  the  poorer  and  richer  classes,  due 
in  the   former  to  the  undermining  influences  of  poverty,  alcoholism, 
trauma,  etc. ;  in  the  latter  to  the  enervating  influences  of  wealth  and 
lack  of  control.     Hysterical  persons,  as  a  rule,  present  stigmata  of 
degeneration.     The  influences  that  incite  and  develop  hysteria  are  all 
those  conditions   that  bring  about  psychic  shock — "moral   traumata," 
as  it  were — and  these  become  doubly  effective  where  they  are  asso- 
ciated with  psychic  fear.     For  this  reason  railway  and  other  accidents 
are   frequent  causes,  oftentimes  not  from  the  actual  injury  done  to 
physical  neural  structures,  but  to  the  intense  shock  or  impression  that 
the  particular  agent  makes  upon  the  hysteric's  mind,  already  receptive 
by  a  state  of  suggestibility,  pathologically  enhanced  in  these  persons. 
It  is  interesting  to  note  that  there  is  often  an  entire  lack  of  proportion 
between  the  provocative  agent  and  the  results  of  its  influence.     There 
is   in  the  minds  of    many  physicians  the  idea  that    the  presence  of 
hysteria  in  the  individual  precludes  organic  disease.     Nothing  could 
be   further   from  the  truth,  as  this  neurosis  may  be  associated   with 
or    superimposed   upon    organic    neural    and    physical   disease.      Fear 
of  the  direful  results  of  onanism,  or  syphilis,  alcohol,  mercury,  phys- 
ical, mental  and  sexual  excesses  may  so  overstrain  the  unstable  psycho- 
neural  mechanism  as  to  produce  the  attack.     Hysterics  may  present 
the  appearance  of  perfect  health.     The  symptoms  affect  mostly  the 
psychic,  motor,  sensory  and  secretory  systems,  but  are  found  in  every 
function  and  every  organ  of  the  body.     Many  of  the  minor  cases  are 
'really  closely  allied  to  those  of  neurasthenia,  and  in  this  country  the 
author  is  rather  constrained  to  believe  that  we  more  frequently  have 
to    deal    with    hystero-neurasthenia    than    hysteria    of   the    pure   type. 
Hysteria   major,   the  grave  type   of  the   disease,   is   characterized   by 
paroxysms  of  an  emotional,  convulsive  character,  of  which  the  French 
school,  and    especially    Charcot,  have    given    us    classic    descriptions. 
During  the  interparoxysmal  period  we  find  tremors,  anesthesias,  par- 
alyses, contractures  and  psychic  conditions  distinctly  peculiar.     This 
may  be   described   as  a  weakening  of  will-power,  a  sensitiveness  to 
mental  and   emotional  influences,  waywardness,  capriciousness,  insta- 
bility of  purpose,  exaggeration  in  statements,  and  a  morbid  desire  to 
attract  attention  to  themselves,  to    elicit    sympathy    and  condolence. 
Acts  and  movements  are,  as  a  rule,  overacted.       The  special  senses 
and  the  vegetative  system  sometimes  present  puzzling  and  interesting 


370  PRACTICAL  HYDROTHERAPY. 

symptoms.  Dana2  says  that  there  are  three  different  phases  of  hysteria 
— the  hysterical  temperament,  hysteria  minor,  and  hysteria  major. 
The  hysterical  temperament  is  something  with  which  all  women  and 
many  men  are  naturally  endowed,  while  in  hysteria  major  we  have 
much  greater  preponderance  of  stigmata  and  much  severer  forms  of 
crises,  largely  of  the  motor  type.  There  is  no  known  pathological 
or  anatomical  change  at  the  base  of  hysteria. 

The  author  believes  that  cases  of  hysteria  are  best  treated  by 
being  placed  under  the  care  of  those  who  make  a  specialty  of  the 
treatment  of  such  diseases.  The  management  of  the  hysteric  requires 
great  care,  thought  and  individualization,  and  it  may  be  stated  that 
individualization  is  the  essential  basis  of  success.  Mental  treatment 
and  moral  control  are  of  the  greatest  importance,  and  this  can  be 
readily  appreciated  when  we  stop  and  reflect  that  this  is  a  psychic 
disease.  It  is  necessary  for  the  physician  to  be  in  full  and  absolute 
control  of  the  patient  and  the  family  subservient  to  his  wishes.  I  live 
courteous  and  respectful  consideration  to  her  symptoms ;  do  not  run 
down  her  suffering,  but  with  a  little  care  and  exercise  of  tact  avoid 
the  issue  gracefully  by  rather  leading  her  through  inuendo  to  believe 
that  her  symptoms  are  not  serious,  that  we  understand  them  well,  and 
that  while  we  do  not  care  to  minimize  the  impression  she  has  of  their 
severity,  still  we  know  them  so  well  and  have  lived  with  them  so 
constantly  that  to  u s  they  present  no  formidable  and  terrifying  effects. 
The  hysteric  is  like  the  driver  who  has  lost  the  reins,  and  as  a  result 
cannot  control  the  animal.  It  is  the  aim  and  object  of  treatment  to 
place  the  reins  within  her  hands,  to  teach  her  how  to  drive.  To  this 
end  a  systematic  attempt  should  be  made  to  cultivate  the  will-power, 
and  this  can  be  accomplished  while  the  physical  upbuilding  is  going 
on.  Nothing  is  more  difficult  to  convey  in  written  language  what 
constitutes  mental  and  moral  control,  and  how  to  exercise  the  '"hand 
of  steel  and  the  glove  of  velvet.**  for  these  will  come  only  with  ex- 
perience and  careful  study  of  cases,  for  no  practitioner  is  too  old  or 
too  learne  1  not  to  pick  up  a  few  new  items  with  each  case  that  comes 
under  his  care.  Moral  treatment  and  mental  control,  then,  include 
the  pleasant  attitude  and  agreeable  relations  that  exist  between  patient 
and  physician  :  the  careful  strengthening  of  the  confidence  and  belief 
that  the  patient  has  in  her  medical  adviser ;  a  judicial  capacity  to 
quickly  and  fairly  judge  of  the  daily  questions  that  will  arise,  and 
which  cannot  be  foreseen ;  the  capacity  to  realize  the  necessity  for  the 
modification  of  treatment  and  the  relaxation  of  rule-  here  and  the 
exercise  of  indomitable  firmness  there ;  ability  to  talk  of  interesting 
topics,  and  by  so  doing  at  times  ignore  her  wishes  and  symptoms  and 
carry  her  far  beyond  her  self-centered  self  into  pleasurable  realms 
and  domains ;  to  be  a  man  capable  of  carrying  a  bright  and  interest- 

2  Dana,  C.  L. :   "Text-Book  of  Nervous  and  Mental  Diseases,"  1S97,  p.   477. 


FUNCTIONAL  XBRVOUS  DISEASES.  371 

ing  ban  in  el  to  her  each  and  every  day,  and  finally  by  constant  cheer- 
fulness, indirect  and  direct  suggestions,  assure  her  of  recovery,  and 
that  in  the  interest  found  in  her  case  you  are  her  kindest  friend  and 
best  adviser. 

.Major  hysteria  requires  the  full  and  complete  treatment  as  out- 
lined by  Dr.  S.  Weir  Mitchell,3  and,  in  the  author's  opinion,  nothing 
short  of  this  will  arouse  the  patient  and  bring  about  the  cure.  This 
treatment  consists  of  isolation,  by  which  the  patient  is  removed  from 
her  home  and  sympathetic  friends,  the  physician  in  charge  having 
full  and  complete  authority.  Oftentimes  the  half-measure  of  isolating 
a  case  in  the  patient's  own  home  is  a  failure,  owing  to  its  being  a 
half-measi:re,  and  the  author  has  long  since  learned  by  sad  mistakes 
its  valuelessness.  In  homely  phrase,  it  should  be  "whole  hog  or 
none."  The  next  essential  is  a  healthy,  firm,  tactful  nurse,  fairly 
well  educated,  and  interested  in  her  patient — a  rarity — for  it  must  be 
remembered  that  for  six  or  eight  weeks  these  two  women  will  be 
together,  within  the  walls  of  one  small  room.  The  daily  routine  starts 
in  the  morning,  on  the  patient's  awakening,  about  seven  or  eight 
o'clock,  with  the  dripping  sheet  at  a  temperature  of  80°  F.,  reduced 
two  degrees  daily  to  60°  F.  for  three  minutes,  with  vigorous  friction, 
while  the  patient  stands  in  a  tub  of  very  hot  water.  Reaction  is 
brought  about  by  a  good  rub  with  warm  Turkish  towels ;  the  patient 
is  then  returned  to  bed  and  given  half  to  one  pint  of  milk,  either  cold 
or  hot,  preferably  the  latter.  A  half  to  one  hour  later  breakfast  is 
served,  and  during  the  forenoon  general  massage  for  a  half  to  one 
hour,  followed  by  another  portion  of  milk,  to  which,  if  the  patient  is 
much  emaciated,  we  may  add  tropon  or  plasmon.  Dinner  with  a 
malt  extract,  and  in  the  afternoon  general  faradism  to  all  the  muscles 
of  the  body,  gentle  at  first,  in  a  few  days  strong  enough  to  produce 
firm  muscular  conti  action.  This  is  again  to  be  followed  by  another 
portion  of  milk,  and  later  by  supper  with  malt  extract.  Before  bed- 
time the  full  pack  at  a  temperature  of  80°  F.,  reduced  two  degrees 
daily  to  60r-  F.  for  one  hour,  followed  by  a  careful  drying  without 
much  friction,  and  the  administration  of  another  portion  of  milk, 
constitute  the  daily  program,  which  may  be  varied  later  by  reading 
and  other  light  occupation.  As  above  stated,  this  treatment  is  best 
adapted  to  those  cases  that  are  bed-ridden,  suffering  from  anorexia, 
emaciation,  anemia  and  pelvic  disease. 

Minor  hysteria  requires  the  same  tactful  management.  They  are 
usually  ambulatory  cases,  and  do  net  require  the  severe  measures  of 
the  major  form  of  the  disease.  We  may  plan  their  treatment  by  first 
regulating  the  bodily  functions,  ordering  a  full  diet,  careful  mastica- 
tion of  food  and  the  free  drinking  of  pure  water.  In  these  cases 
exercises    are    very    valuable  and  not  altogether  appreciated,  and  the 

3  Mitchell,   S.   Weir:   "Fat  and  Blood,"   1888. 


372  PRACTICAL  HYDROTHERAPY. 

patient  should  be  urged  to  use  the  bicycle,  play  tennis  or  golf  where 
there  are  no  contraindicating  symptoms.  These  exercises  instruct 
and  stimulate  the  mind,  and  this  constitutes  one  of  their  principal 
values.  Hydrotherapy  is  the  best  remedy,  and  forms  an  essential  part 
of  all  methods  of  treatment  of  this  disease.  It  should  take  front 
rank,  for  cold  water  acts  as  a  powerful  agent  to  stimulate  the  cir- 
culation, arouse  mental  action,  bring  about  all  those  intricate  changes 
of  metabolism  so  much  needed,  and  is,  in  fact,  par  excellence,  the 
tonic  and  the  sedative.  It  must  be  borne  in  mind  that  in  all  measures 
reaction  must  be  secured,  and  that  our  object  is  to  gently  and  gradu- 
ally train  the  patient  to  take  the  treatment  without  fear.  In  those 
cases  that  cannot  secure  the  benefits  of  institutional  hydrotherapy  the 
dry  full  pack  for  one-half  hour  to  one  hour,  followed  by  an  affusion 
at  a  temperature  of  80°  F.  while  the  patient  stands  in  a  tub  of  hot 
water,  will  oftentimes  prove  of  material  value.  The  water  of  the 
affusion  should  be  reduced  two  degrees  daily  until  60°  F.  is  reached. 
In  the  institutional  management  of  these  cases  the  author  begins  with 
the  electric  light  bath,  hot  air  or  vapor  until  the  patient  perspires, 
and  follows  this  with  the  dripping  sheet  for  three  minutes  at  a  tem- 
perature of  80°  F.,  with  vigorous  friction,  reducing  the  temperature 
two  degrees  daily,  stopping  at  60°  F.  As  soon  as  this  is  reached  a. 
change  is  made  to  the  following:  Electric  light  bath  to  perspiration, 
followed  by  the  horizontal  or  circular  rain  bath  at  a  temperature  of 
100°  to  104°  F.  for  one  and  one-half  to  two  minutes,  reduced  to  60° 
F.  for  one-fourth  minute.  This  treatment  may  be  continued  a  week, 
at  the  end  of  which  time  use  the  following:  Electric  light  bath  until 
free  perspiration,  followed  by  the  horizontal  rain  bath  at  a  temper- 
ature of  60°  F.  to  the  entire  body  and  the  jet  doucne  at  the  same 
temperature  to  the  spine  and  back  of  legs  for  ten  or  twenty  seconds. 
After  a  short  while  much  lower  temperatures  may  be  employed — 
from  50°  to  45°  F. —  but  they  should  be  given  for  periods  not 
exceeding  two  to  five  seconds  and  under  good  pressure.  These  cases 
stand  the  Scottish  or  alternating  douche  quite  well,  especially  to  the 
spine  and  legs,  though  care  must  be  exercised  to  avoid  sensitive  areas 
and  hysterogenetic  zones,  which  should  be  protected  with  hot  towels 
during  its  application.  Administer  the  treatment  as  follows :  Electric 
light  bath  until  free  perspiration,  and  as  soon  as  this  takes  place  apply 
the  Scottish  douche  at  a  temperature  of  105°  to  110°  F.  for  one- 
fourth  to  one-half  minute,  alternating  with  a  temperature  of  60°  to 
50°  F.  for  two  to  ten  seconds,  three  to  six  alternations,  all  under  a 
pressure  of  from  fifteen  to  thirty  pounds.  The  Scottish  douche  should 
never  be  applied  in  this  manner  until  we  have  trained  our  patient  to 
stand  low  temperatures  and  considerable  pressure.  The  best  time 
for  the  administration  of  the  douche  is  during  the  morning  hours 
between  breakfast  and  dinner. 


V(  TIONAL  NERVOUS  DISEASES.  375 

There  are  certain  excitable  types  of  hysteria  to  which  the  above 
cannot   be  applied  at   the  commencement  of  the  treatment,  and    for 

these  cas«s  we  employ  the  full  wet  pack  at  70°  F.  for  one  hour, 
followed  by  the  half  bath  for  five  minutes  at  80°  F.,  reducing  the 
pack  one  degree  daily  to  60°  F.  and  decreasing  temperature  of  half 
bath  in  the  same  manner  to  70°  F.  Later  we  may  use  the  treatment 
allow  mentioned,  exercising  care  and  caution.  Aftei  recovery  the 
author  has  seen  good  results  from  the  continuance  of  the  cold  hydri- 
atic  applications  daily  for  many  months,  and  this  may  consist  of  the 
affusion,  cold  shower  or  cold  sponge  taken  by  the  patients  daily  in 
their  homes.  These  cases  should  be  urged,  whenever  possible,  t  i 
indulge  in  swimming,  as  it  is  an  excellent  exercise,  diverting  to  the 
mind,  and  secures  at  the  same  time  the  good  effects  of  tonic  cold 
water,  and  this  is  true  in  like  manner  of  surf  bathing,  although  the 
majority  of  cases  in  inland  towns  would  be  denied  this  pleasure.  As 
associated  treatments  of  great  value  may  be  mentioned  faradic  and 
static  electricity,  galvanism  in  large  doses  through  the  abdomen,  and 
general  massage. 

Drugs  have  no  place  in  the  treatment  of  hysteria  itself,  and  the 
use  of  bromides,  chloral  and  morphine  are  to  be  most  heartily  con- 
demned. For  nutritional  effects  we  may  prescribe  malt,  iron,  hypo- 
and  glycerophosphates. 

Special  symptoms  arise  during  the  course  of  the  disease  that  may 
call  for  treatment,  and  of  these  aphonia  is  best  met  by  the  application 
of  the  ice1bag  or  throat  compress  and  cold  jet  douche  to  the  nape  of 
the  neck.  The  faradic  current  within  the  larynx  sometimes  brings 
about  restoration. 

Anorexia  is  best  met  by  a  glass  of  ice-water  one  hour,  and,  in 
addition,  the  ice-bag  to  the  epigastrium  for  one-half  hour,  immediately 
before  meals.  In  administering  general  treatment  where  these  symp- 
toms are  present  it  is  well  to  give  the  jet  to  the  epigastrium,  or  where 
this  cannot  be  borne  a  spray  douche  of  considerable  strength.  Hct 
and  cold  lavage  and  intragastric  faradization  sometimes  help. 

Convulsions  demand  that  the  interested  sympathizers  be  shut  out 
of  the  room  and  a  dash  of  cold  w-ater  made  to  the  face.  Where  this 
does  not  stop  the  attack,  apomorphia,  hot  and  cold  spinal  sponges 
and  the  neutral  bath  are  the  best  measures. 

For  contractures  we  can  use  the  fomentation,  followed  by  the 
cold  sponge,  or,  what  is  best,  the  Scottish  douche.  It  will  sometimes 
be  found  that  movements  and  massage  while  in  the  warm  full  bath 
or  very  hoi  pack  will  aid  in  restoring  them.  Associated  measures  of 
assistance  will  be  found  in  massage  and  static  sparks  applied  to  the 
part.  Suggestion  and  encouragement  to  relax  duiing  treatment 
should  always  be  carried  out. 

Hyperesthesia  and  pain   are  best  met  by  the  general   treatment, 


374  PRACTICAL  HYDROTHERAPY. 

although  the  application  of  the  fomentation  followed  by  a  stimu- 
lating compress  or  the  cold  affusion,  douche  and  the  Scottish  douche 
are  most  useful.     The  author  prefers  the  Scottish  douche. 

Anesthesia  and  paresthesia  are  overcome  by  general  methods, 
which  consist  of  a  heating  procedure  followed  by  the  Scottish  douche 
to  the  spots  affected.  The  static  spark  is  very  effective  in  these  cases. 

Paralysis  of  any  part  should  demand  the  application  of  the 
Scottish  douche  to  it,  at  the  same  time  urging  the  patient  to  move 
the  part  and  assuring  her  that  it  is  possible.  Faradic  electricity  and 
massage  are  additional  valuable  methods. 

Vomiting  is  best  controlled  by  complete  isolation  and  the  general 
treatment  first  described. 

Epilepsy. 

Under  the  term  epilepsy  we  consider  many  conditions  that  are, 
generally  speaking,  little  appreciated,  for  by  this  term  we  do  not 
simply  mean  a  common  convulsion  or  "fit,"  but  states  of  dual  personal- 
ity, dreamy  states  of  consciousness,  peculiar  phases  of  transient  uncon- 
sciousness, localized  or  Jacksonian  attacks,  and  lastly  the  well-known 
convulsive  attacks  that  are  the  genuine  or  essential  neurosis.  It  was 
a  disease  held  sacred  by  the  ancients,  by  many  savage  tribes  and 
peoples;  ir  fact,  it  often  protected  the  individual  in  the  same  manner 
as  did  insanity.  Epilepsy  is  almost  prima  facie  evidence  of  degener- 
ation, physically,  neuropathically  or  psychopathically.  It  is  frequently 
hereditary,  its  onset  is  often  simply  a  transformation  of  other  neuro- 
psychic  disease,  alcoholism  in  parents  forming  the  basis  of  many 
cases.  While  epilepsy  may  appear  at  any  age,  it  is  essentially  a  disease 
of  the  first  two  decades  of  life.  Convulsions  in  infantile  life  should 
always  demand  careful  watching  and  be  presumed  to  be  of  epileptic 
origin,  for  a  tendency  to  gloss  over  a  convulsion  exists  with  remark- 
able frequency  among  physicians.  The  attacks  may  commence  at  any 
age,  even  in  the  sixties.  The  sexes  are  about  equally  divided.  The 
author  questions  seriously  as  to  whether  the  exciting  causes  of  epi- 
lepsy possess  the  value  given  to  them  by  some  writers,  especially 
phimosis,  ear  and  ocular  troubles,  but  rather  believes  that  the  case 
would  have  had  epilepsy  anyhow,  and  that  its  excitation  would  have 
resulted  from  other  causes  equally  insignificant  had  these  not  been 
present.  In  other  words,  the  true  condition  is  one  in  the  cortex, 
latent  or  active,  and,  no  matter  how  brought  into  action,  it  is  essen- 
tially cortical,  a  degenerative  disease,  the  attacks  of  which  may  be 
and  are  piecipitated  by  external  or  systemic  conditions,  but  these 
bear  the  relation  of  the  match  or  fulminate  to  the  charge  proper.  It 
is  an  axiom  to  which  there  is  no  exception  that  the  more  nearly 
correct  and  accurate  we  can  make  the  epileptic's  functions  the  better 
he  is  off,  and   for  this  reason  his  ocular  and  aural  lesions  must  be 


FUNCTIONAL  XERVOUS  DISEASES.  375 

corrected,  his  teeth  put  in  perfect  condition,  adenoids  and  enlarged 
tonsils  removed,  mouth-breathing  corrected,  circumcision  performed, 
hemorrhoids  removed,  uterine  and  ovarian  disease  corrected,  tox- 
emias removed,  but  all  with  the  very  definite  idea  in  mind  that  by  so 
doing  we  are  not  treating  the  epilepsy  per  se,  but  simply  removing 
those  burdens  that  by  their  irritation  are  prone  to  cause  a  recurrence 
of  the  attacks  and  by  their  presence  and  persistence  interfere  with  the 
management  of  the  epileptic  state.  1  say  advisedly  the  management 
of  the  epileptic  state,  for  1  wish  it  to  be  understood  clearly  that  we 
should  not  focus  our  mind  upon  the  epileptic,  but  rather  upon  his 
state  and  condition,  and  in  so  doing  treat  him  rather  than  his  disease. 
Depravity  of  nutrition  forms  a  basis  frequently  for  the  commence- 
ment of  epilepsy,  and  in  many  other  cases  is  an  accompaniment.  Of 
all  sources  for  the  production  of  attacks,  the  most  fruitful  cause  has, 
in  the  author's  experience,  been  the  gastro-intestinal  tract,  for  these 
cases  are  notoriously  flagrant  violators  of  all  dietetic  laws,  being 
large,  irregular,  frequent  and  imprudent  eaters,  careless  of  kind  or 
quality  of  food,  self-induigent.  with  appetites  hard  to  control  and 
seeming  pertinacious  desire  for  things  known  to  produce  their  con- 
vulsions. The  pathology  has  so  far  eluded  the  most  careful  search, 
although  theories  galore  have  been  suggested.  Perhaps  better  methods 
of  research  will  reveal  the  lesion,  though  at  the  present  time  a  cortical 
instability  of  the  neuron  bodies  there  located,  with  an  easy  upsetting 
from  various  toxic  and  other  causes,  is  the  generally  accepted  con- 
dition. The  attacks  are  due  to  sudden  explosions  or  discharge  of 
nerve  force,  the  seat  of  which  is  in  the  large  motor  neuron  bodies, 
due  probably  to  the  weakening  of  the  sensory  control.  The  aurae,  fit 
and  post-epileptic  stages  are  too  classic  and  well  known  to  need 
elucidation  here.  Epileptics  whose  attacks  are  infrequent  may  live 
their  allotted  time  and  even  do  good  work,  though  epilepsy  has  a 
tendency  to  shorten  life.  The  best  cases  are  those  that  occur  after 
the  twentieth  year,  or  where  the  attacks  are  either  diurnal  or  nocturnal. 
Of  all  the  diseases,  none  demands  more  active  and  prompt  treat- 
ment than  epilepsy,  and  in  its  management  rather  than  in  treatment 
lies  the  question  of  success.  Cases  must  be  treated  early  and  vigor- 
ously managed.  It  may  be  considered  axiomatic  that  children  who 
have  had  one  or  more  convulsions  must  be  presumably  candidates 
for  epilepsv  in  later  life,  and  for  this  reason  the  danger  of  the  condi- 
tion should  be  explained  to  the  parent  and  the  child  kept  under  care- 
ful medical  supervision,  management  and  treatment  ±cr  a  period  of 
not  less  than  three  years.  Were  this  plan  followed  out,  it  is  the  confi- 
dent opinion  of  the  author  that  we  would  have  fewer  cases  of  epilepsy 
than  at  the  present  time,  and  the  need  for  such  urgent  measures  seems 
to  have  made  but  little  impression  upon  the  average  medical  mind. 
Those  whose  practice  along  certain  lines  has  brought  them  intimately 


376  PRACTICAL  HYDROTHERAPY. 

in  touch  with  epileptics  and  their  management,  learn  to  wonder  at  the 
tales  of  apparently  gross  neglect  with  cases  of  early  and  tender  years. 
In  the  management  of  epileptics  after  the  neurosis  has  fully  devel- 
oped, moral  control  enters  largely,  and  we  should  exact  from  these 
cases  the  same  obedience  that  is  expected  from  the  common  soldier, 
and  by  so  doing  a  wholesome  respect  and  confidence  are  thereby  en- 
gendered. Truth  should  be  inculcated,  for  these  cases  have  a  ten- 
dency along  lines  that  deviate  from  the  strict  rule.  In  the  best  bal- 
anced of  individuals  there  should  exist  at  all  times  a  normal  restraint 
of  passions,  both  mental  and  physical,  and  in  this  respect  the  epileptic 
must  be  taught  to  never  give  way  to  angry  feelings  and  to  restrain 
himself  at  all  times.  Emotional  states  are  bad,  and  where  persisted 
in  frequently  of  themselves  produce  attacks,  and  at  the  same  time 
tend  to  loosen  the  hold  the  epileptic  should  at  all  times  maintain 
upon  himself.  In  like  manner  excitement  and  over-stimulation  that 
come  from  the  reading  of  exciting  literature,  especially  "dime  novels," 
may  not  only  upset  much  that  has  been  done  for  him,  but  may  actually 
form  the  basis  of  post-epileptic  conditions,  a  case  of  which  has  re- 
cently occurred  in  the  author's  practice.  Temperate  mental  activity 
is  favorable,  for  it  must  be  understood  that  the  epileptic's  brain,  like 
that  of  any  other  human  being,  tends  rapidly  to  go  to  seed  and  to  grow 
weeds  when  untended.  To  this  end,  interesting,  unexciting  and  in- 
structive novels,  light  history  and  books  of  travel  may  be  read.  Even 
more  essential  than  moderate  mental  occupation  is  the  industry  of  the 
body,  and  while  we  must  train  the  mind,  at  the  same  time  the  hands 
should  be  educated  in  the  arts  and  crafts,  taking  special  pains  to  cul- 
tivate the  inherited  and  acquired  aptitudes  of  the  individual.  The 
epileptic  ic  a  pariah,  shut  out  from  many  of  the  social  and  pleasurable 
intercourses  of  life,  refused  responsible  mental  positions  on  account 
of  his  incapacity,  and  physical  occupations  because  of  the  attendant 
risks,  danger  of  lawsuits,  and  other  troubles  that  may  arise  in  shops 
under  ordinary  conditions.  It  thus  stands  to  reason  that  the  mental 
and  physical  education  of  the  epileptic  is  a  peculiar  and  especial  sphere 
of  action  to  which  men  and  women  must  be  trained  in  order  to  secure 
proper  results.  In  colonies,  and  colonies  alone,  can  these  ideal  condi- 
tions of  moral,  mental  and  physical  training,  accompanied  by  the  ad- 
vanced methods  of  treatment  of  the  disease,  be  found,  and  for  this 
reason  the  author  believes  it  is  incumbent  upon  the  State  to  establish 
for  the  benefit  of  these  unfortunates  an  institution,  farm  or  colony 
where  they  may  learn,  labor  and  enjoy  not  only  existence,  but  the 
pleasure  and  fruits  of  occupation.  Theoretically  this  is  true ;  prac- 
tically, as  carried  out  at  colonies  established  in  the  States  of  Xew 
York  and  Ohio,  it  is  found  to  be  correct.  For  more  than  one  reason, 
marriage  should  be  forbidden  to  the  epileptic,  not  alone  because  of 
the  canons  of  hard  common  sense,  but  because  of  the  rights  of  unborn 


FUNCTIONAL  NERVOUS  DISEASES.  377 

generations.  Not  only  should  it  be  forbidden,  but  laws  in  each  State 
in  the  Union  should  be  so  enacted  as  to  make  it  impossible  for  them 
to  marry.  Physicians  should  cast  their  weight  against  the  marriage 
of  defectives  because  of  its  supposed  value.  This  is  a  mistake,  an 
illusion ;  for  while  it  is  normal  to  procreate,  still  we  find  that  the 
household  cares,  worries  and  the  responsibilities  of  the  rearing  of 
children  are  oftentimes  burdens  that  it  is  hard  for  the  strong  and 
healthy  to  bear,  let  alone  those  who  are  physically,  nervously  and  men- 
tally incompetent,  such  as  the  epileptic.  Where  such  an  unfortunate 
event  as  marriage  has  been  consummated,  it  is  the  author's  opinion 
that  procreation  in  such  an  event  must  be  denied  them,  for  it  is  often 
the  case,  and  especially  true  with  these  individuals,  that  like  begets 
like. 

In  the  true  management  of  the  epileptic  state,  certain  hygienic 
and  dietetic  laws  must  be  enforced,  among  which  may  be  mentioned 
the  avoidance  of  tobacco,  liquors,  wines,  coffee,  tea,  and  the  other 
useless  luxuries  that  harm  rather  than  do  good.  The  digestion,  as  a 
rule,  is  weak,  the  appetite  large,  abnormal,  and,  as  a  result  of 
the  putrefactive  changes  taking  place  in  the  stomach  and  intestines, 
toxins  are  absorbed,  causing  frequent  and  recurring  attacks.  The 
food  must  be  well  masticated,  cutting  it  up  finely  before  starting  to 
eat.  The  diet  should  be  a  mixed  one.  in  which  a  small  portion  of  meat, 
once  daily  at  midday,  is  allowed.  Green  vegetables,  fruits,  cereals, 
the  limitation  of  starchy  food  and  sugar,  should  be  insisted  upon. 
The  author  mentions  to  condemn  the  habit  of  eating  candy  between 
meals,  and  has  noticed  in  one  or  two  cases  improvement  from  stop- 
ping its  use.  At  times  benefit  is  derived  by  a  few  days  of  milk  diet 
alone.  Plenty  of  water  should  be  drunk  between  meals,  and,  where 
gastric  disturbances  are  great,  a  tumbler  of  hot  water  in  which  ten 
grains  of  bicarbonate  of  soda  has  been  dissolved  may  be  taken  before 
breakfast.  Golfing  is  a  most  excellent  exercise  for  out  of  doors,  walk- 
ing next ;  indoors  the  punching-bag  is  a  suitable  form  for  these 
cases.  While  the  exercise  may  be  active  and  sufficient  to  stimulate 
the  circulation  of  the  blood,  it  should  be  just  short  of  fatigue.  Amuse- 
ments in  cases  where  attacks  are  not  frequent  may  embrace  the  the- 
ater, provided  the  attendance  is  at  a  matinee  and  that  the  melodrama 
is  avoided.  Sleep  must  be  secured  in  large  amounts,  and  to  this 
there  is  no  exception.  The  author  believes  that  the  method  of  treat- 
ment to  be  adopted  in  these  cases  consists  of  the  administration  of 
the  bromide  of  soda  or  strontium  night  and  morning,  well  diluted 
with  water,  to  the  extent  of  forty  or  sixty  grains  daily,  with  the  use 
of  tonics  and  digestants  given  after  meals.  The  combined  treatment 
— mental,  moral,  physical,  hygienic,  dietetic,  medicinal  and  hydro- 
therapeutic — is  essential,  and  the  utilization  of  only  one  or  two  parts 
of  the  plan  usually   results  in   failure  to  benefit.     Hydrotherapy  is 


378  PRACTICAL  HYDROTHERAPY. 

now  univd sally  acknowledged  to  form  an  essential  part  of  the  sys- 
tem here  laid  down.  With  a  little  ingenuity  it  can  oftentimes  be  ad- 
ministered at  home.  Home  treatment  may  commence  with  the  sponge 
bath  daily  at  a  temperature  of  90°  F.,  reducing  daily  two  degrees  F. 
until  70°  r  reached.  This  should  be  followed  by  rapid  friction  with 
a  rough  Turkish  towel.  As  soon  as  the  patient  is  accustomed  to  this 
procedure  we  may  give  the  warm  full  bath  at  100°  F.  for  five  or  ten 
minutes,  following  same  by  an  affusion  at  a  temperature  of  65°  F., 
or  with  a  rapid  cold  sponge  and  hard  friction  with  a  dry  Turkish 
towel. 

An  excellent  procedure  for  home  treatment  that  the  author  can 
recommend  is  the  use  of  the  salt  glow  or  rub  until  the  skin  is  well 
reddened,  followed  by  the  warm  full  bath,  cold  Lponge  or  affu- 
sion and  friction  as  above  described.  It  is  really  astonishing  how  rap- 
idly pationts  improve  under  this  treatment.  Another  method  that 
can  be  used  in  the  home  is  the  half  bath  at  a  temperature  of  85°  to 
80°  F.  for  five  to  ten  minutes,  accompanied  by  friction,  finishing  the 
treatment  with  an  affusion  at  60°  F.  to  the  spine.  These  procedures 
can  be  carried  out  in  almost  any  farmhouse  or  city  residence  where 
even  a  moderate  degree  of  intelligence  exists,  but  it  has  been  the 
author's  sad  experience  that  the  treatment  is  pursued  with  enthusiasm 
and  care  for  only  a  very  short  time.  This  is  another  reason  why  colo- 
nies and  sanatoria  secure  better  results,  pursuing  their  treatment,  as 
they  do,  carefully,  persistently  and  painstakingly.  In  institutions  the 
proper  method  is  to  commence  with  a  sweating  procedure,  such  as  the 
electric  light  bath,  hot  air,  superheated  dry  hot  air  or  vapor,  followed 
by  a  tonic  method.  The  author  prefers  the  electric  light  bath  until 
perspiration  has  taken  place,  followed  by  the  horizontal  or  circular 
rain  bath  at  a  temperature  of  100°  F.  for  one  to  one  and  one  half 
minutes,  pressure  twenty  to  thirty  pounds.  Reduce  temperature  one 
degree  daily  until  65°  F.  is  reached.  At  this  point  we  may,  in  addi- 
tion to  the  foregoing,  administer  a  jet  douche  to  the  spine  and  legs 
for  one-fourth  to  one-third  minute  at  a  temperature  of  65°  F.,  under 
pressure  of  twenty-five  to  thirty  pounds.  All  other  diseases  that  are 
present  must  be  treated,  especially  malaria,  rheumatism,  gout  and 
syphilis. 

To  sum  up,  we  may  say  that  in  the  management  of  the  epileptic 
we  should  exercise  perfect  control ;  arrange  his  mental,  moral  and 
physical  activities ;  have  him  avoid  nervous  excitement,  irritation  and 
exhaustion;  grant  him  rational  occupation  and  amusement;  insist 
upon  a  simple,  abstemious  dietary,  free  water-drinking,  abundance  of 
sleep,  ample  outdoor  exercise,  regulation  of  all  bodily  functions,  the 
intelligent  administration  of  bromides,  and,  finally,  painstaking  and 
persistent  hydrotherapy,  associated  with  massage,  and  electricity  where 
indicated. 


FUNCTIONAL  NERVOUS  DISEASES.  379 

Chorea. 

Chorea,  or  "St.  Vitus'  dance,"  is  a  functional  neurosis  character- 
ized by  irregular  jerkings  and  incoordinate  movements,  occurring 
during  the  later  periods  of  childhood,  most  often  between  five  years 
and  puberty,  more  common  in  girls  than  in  boys,  and  being  present 
most  frequently  in  the  spring.  The  Hebrew  and  German  races  are 
especially  prone  to  the  disease.  The  movements  vary  in  intensity 
from  slight,  careless,  irregular  twitchings  of  co-ordinate  groups  of 
muscles  to  violent  jerkings,  writhings  and  contortions.  The  child 
winks,  screws  up  its  face,  drops  things,  stumbles  and  jerks.  Speech  is 
thick,  eating  and  dressing  become  difficult.  Rheumatism  bears  a  close 
etiological  relation  to  chorea,  and  endocarditis  occurs  in  the  course 
of  the  disease  with  considerable  frequency.  Infectious  diseases,  over- 
study,  wort}',  anemia,  malnutrition,  all  seem  to  be  predisposing  causes. 
Important  factors  in  the  production  of  the  attack  are  fright,  worry 
and  emotional  disturbances,  these  being  the  most  frequent  in  the 
author's  cases.  Excitement  makes  the  movements  worse ;  physical 
exertion  likewise  increases  them.  There  is  no  pain,  anesthesia  or 
suffering,  though  the  mental  processes  are  slowed  and  the  child  some- 
what apathetic.  Cases  relapse  with  a  fair  degree  of  frequency,  espe- 
cially about  the  vernal  and  autumnal  equinoxes.  The  pathology  is 
that  of  an  intense  hyperemia — dilatation  of  the  blood-vessels,  small 
hemorrhages  located  in  the  gray  matter  of  cortex,  basal  ganglia  and 
spinal  cord.  The  meninges  and  pyramidal  tracts  are  often  involved. 
The  interruption  of  the  involuntary  impulses  by  diseased  foci  causes 
the  irregular  movements.  In  general  terms,  it  may  be  said  that  there 
is  a  neuronic  instability  brought  about  by  the  action  of  some  toxin 
upon  the  higher  nerve  centers.  The  prognosis  as  to  death  and  recov- 
ery is  excellent,  death  hardly  ever  occurring  (none  in  the  author's 
cases)  and  recovery  being  the  rule.  The  disease  lasts  from  six  weeks 
to  six  months.  Two  cases  have  recovered  in  the  author's  practice 
after  three  and   four  years'   continuous   duration. 

In  the  treatment  of  chorea  the  child  should  be  at  once  removed 
from  school,  and  freedom  from  excitement,  worry  and  annoyance 
secured.  The  writer  is  constrained  to  believe  that  a  number  of  his 
cases  of  chorea  have  been  brought  about  by  the  over-strain  that  re- 
sulted from  the  competition  for  the  prizes  of  school  life.  Rest  is 
one  of  the  essential  factors,  if  not  the  sine  qua  non,  in  the  treatment 
of  the  disease,  and  where  the  jerkings  are  severe  it  must  be  complete 
and  in  bed.  The  diet  must  be  full  and  generous,  and  the  ordinary 
meals  supplemented  with  milk,  tropon,  plasmon,  etc.  Copious  water- 
drinking  is  insisted  upon  to  secure  active  secretions.  The  author's 
plan  of  treating  these  cases,  and  against  which  he  has  yet  to  record  a 
failure  where  it  was  maintained  for  any  reasonable  length  of  time,  is 


380  PRACTICAL  HYDROTHERAPY. 

the  following:  The  child  is  kept  quiet  and  at  rest,  if  necessary  in  bed; 
Fowler's  solution  of  arsenic  in  rapidly  increasing  doses  is  adminis- 
tered, the  diet  corrected,  and  hydrotherapy  instituted.  If  the  twitch- 
ings  and  jerkings  are  severe  the  child  should  be  placed  in  a  neutral 
bath  at  a  temperature  of  96°  F.  and  kept  there  for  one  or  two  hours. 
This  will  be  a  difficult  task  unless  we  have  some  one  who  will  stay  by 
the  bath-tub  and  entertain  the  patient  by  means  of  miniature  sail-boats 
and  other  aquatic  toys  which  can  easily  be  purchased  Other  cases 
are  placed  at  once  upon  a  dripping  sheet  in  the  morning  at  a  tem- 
perature of  90°  F.  for  three  minutes,  with  vigorous  friction,  followed 
by  the  use  of  dry  hot  Turkish  towels  until  reaction  is  secured.  The 
temperature  of  the  sheet  may  be  dropped  two  degrees  daily  until  70° 
F.  or  even  60°  F.,  in  the  case  of  larger  children,  is  reached.  In  the 
evening  wj  may  employ  the  general  wet  pack  at  a  temperature  of  70° 
F.  for  three-quarters  to  one  hour,  followed  by  a  rapid  cold  sponge 
or  alcohol  rub,  finally  drying  the  patient  with  warm  Turkish  towels 
and  securing  good  reaction.  In  the  institutional  management  of  cho- 
rea we  may  employ  the  electric  light  or  hot-air  bath  until  perspiration 
takes  place,  followed  by  the  horizontal  or  circular  rain  bath  at  a  tem- 
perature of  100°  F.  for  one  minute,  under  fifteen  to  twenty  pounds' 
pressure,  and  reduced  to  70°  or  even  60°  F.  The  writer  has  admin- 
istered this  temperature  successfully  to  children  of  the  age  of  five 
years.  In  older  cases  we  may,  in  the  place  of  or  after  the  horizontal 
rain  bath,  employ  the  spray  douche  to  the  entire  body  at  a  tempera- 
ture of  70°  F.  for  one-fourth  to  one-third  minute,  under  pressure  of 
fifteen  or  twenty  pounds,  gradually  reducing  the  temperature  daily 
to  60°  F.  and  increasing  the  pressure  to  thirty  pounds.  Some  authors 
advise  the  use  of  sweating  procedures,  such  as  hot  air  for  ten  to  twenty 
minutes,  followed  by  the  full  dry  pack  for  thirty  minutes  and  a  sub- 
sequent rest  of  one  hour.  The  writer's  experience  has  not  been  satis- 
factory with  this  method  of  treatment.  Cardiac  complications  do  not 
contraindicate  hydrotherapy,  but  such  cases  are  usually  benefited  by 
its  use.  In  cases  where  endocarditis  exists  the  precordial  compress 
or  ice-bag  should  be  employed.  As  associated  methods  we  frequently 
find  general  massage  and  central  galvanization  of  brain  and  spine 
of  considerable  value.  A  trip  to  the  country  or  sea-shore  and  surf- 
bathing  form  an  excellent  finish  to  such  cases.  Mineral  waters  in- 
ternally seem  to  possess  no  value,  although  some  authorities  recom- 
mend the  external  use  of  the  waters  of  the  hot  springs  of  Virginia, 
Arkansas,  and  Las  Vegas,  New  Mexico. 

Exophthalmic  Goitre. 

Exophthalmic  goitre,  Graves'  or  Basedow's  disease,  is  a  chronic 
neurosis  oi  the  sympathetic  nervous  system,  characterized  by  tachy- 
cardia, enlargement  of  the  thyroid  gland,  protrusion  of  the  eyeballs, 


FUNCTIONAL  NERVOUS  DISEASES.  381 

nervous  irritability  and  exhaustion,  muscular  tremor  and  marked 
vasomotor  symptoms.  The  disease  occurs  most  frequently  in  fe- 
males, my  private  record  showing  a  ratio  of  six  to  one.  It  occurs 
most  frequently  in  women  between  the  ages  of  fifteen  and  thirty-five 
years — that  is  to  say,  the  period  of  greatest  reproduction  and  fecun- 
dity. It  occurs  equally  among  the  married  and  unmarried,  but  is 
more  frequent  in  neuropathic  families  and  individuals.  The  immedi- 
ate causes  that  are  likely  to  precipitate  this  neurosis  are  anything 
that  puts  emotional  strain  upon  the  nervous  system,  such  as  fright, 
worry,  grief,  and  prolonged  anxiety.  At  present  the  action  of  these 
factors  in  its  production  is  unknown.  The  secretion  of  the  thyroid 
gland  is  increased  and  probably  altered.  The  essential  symptoms  are: 
( 1 )  Increased  heart-beat  and  pulsating  arteries,  the  pulse-beat  ranging 
from  120  to  200  per  minute,  the  arteries  being  soft  and  dilated,  at- 
tacks of  palpitation  occurring  frequently;  (2)  the  thyroid  gland  is 
enlarged  and  a  thrill  or  bruit  felt;  and  (3)  the  exophthalmos  is  usu- 
ally pronounced,  bilateral,  with  pupils  normal.  A  fine  vibratory  tre- 
mor, nervousness,  insomnia,  diarrhea,  sweating,  and  lessened  elec- 
trical resistance  are  usually  present.  Partial  or  abortive  cases  occur 
in  which  there  are  increased  heart-beat,  goitre,  tremor,  sweating  and 
nervousness,  these  being  frequently  mistaken  for  neurasthenia.  Ner- 
vous complications  frequently  occur,  especially  hysterical  attacks. 

The  real  pathology  is  unknown,  but  the  author  accepts  its  nerve 
origin,  as  a  result  of  which  an  excess  of  secretion  from  the  thyroid 
gland  is  thrown  into  the  circulation,  causing  the  symptoms.  It  is 
believed  that  nerve  tissues  require  a  certain  amount  of  thyroid  secre- 
tion for  their  natural  functionation.  The  goitre  and  exophthalmos 
are  due  to  the  vasomotor  paresis,  and  the  rapid  heart  beat  to  im- 
pairment of  the  inhibitory  fibers  of  the  spinal  accessory  nerve. 

The  author  has  very  definite  and  fixed  ideas  concerning  the  treat- 
ment of  exophthalmic  goitre.  His  experience  has  been  that  the  dis- 
pensary or  ambulatory  treatment  of  these  cases  is  most  unsatisfactory, 
and  that  results  that  are  satisfactory  are  rarely  obtained.  Per  contra, 
he  has  found  that  the  sanatorium  or  hospital  management  has  produced 
excellent  results,  often  in  cases  that  had  previously  tried  many  ac- 
cepted methods  of  treatment. 

The  prime  factor  in  the  treatment  of  this  disease  is  to  secure  the 
patient's  hearty  co-operation  and  a  sufficient  length  of  time  in  which 
to  accomplish  the  work,  and  unless  these  are  secured  the  treatment 
might  as  well  be  given  up,  as  otherwise  failure  is  ahead.  The  time  re- 
quired for  proper  sanatorium  treatment  ranges  from  four  to  six  months. 

The  first  thing  to  do  is  to  secure,  as  far  as  possible,  perfect  rest. 
By  this  is  meant  that  the  patient  is  put  to  bed  and  kept  there,  on  her 
back,  without  getting  up,  for  one  or  two  months.  It  means  freedom 
from  worry  and  excitement,  absence  from  household  cares,  husband, 


382  PRACTICAL  HYDROTHERAPY. 

children,  and  the  vexing  servant  problem ;  a  highly  nutritious  mixed 
diet,  sufficiently  nitrogenized — that  is  to  say,  three  meals  daily,  with 
milk,  plasrnon  or  koumyss  between  meals.  Green  vegetables  should 
be  eaten  and  water  freely  drunk.  Xo  alcohol,  tea,  coffee  or  tobacco 
is  allowed.  Flesh  and  fat  must  be  put  on;  unless  the  weight  is  in- 
creased the  patient  is  not  improving.  The  author  has  definite,  fixed 
ideas  with  regard  to  the  value  of  the  drugs  usually  recommended  in 
this  neurosis,  viz.,  belladonna,  strophanthus,  sparteine,  bromides,  etc. 
For  temporary  non-curative  use  they  occasionally  fill  the  bill;  as  ulti- 
mately influencing  recovery  their  value  is  nil.  I  have  never  seen  any 
good  from  animal  extracts,  thyroidectin  or  the  serum  of  thyroidec- 
tomized  goats,  although  it  has  been  given  careful  trial.  Potassium  per- 
manganate tablets  of  one  grain  each,  coated  so  as  to  dissolve  only  in 
the  intestinal  tract,  are  sometimes  useful  as  an  intestinal  antiseptic. 
Surgery  has  entered  the  field  and  obtained  some  good  results,  but 
the  high  death-rate  of  12  to  20  per  cent,  makes  us  hesitate  until  all 
other  means  have  been  duly  tried.  This  does  not  apply  to  surgical 
work  in  the  removal  of  intranasal  and  pharyngeal  growths,  the  re- 
moval of  which  has  in  several  cases  been  beneficial  to  patients.  Two 
remedies  are  of  unquestioned  and  permanent  value — hydrotherapy  and 
galvanism. 

In  the  treatment  of  these  cases  by  hydrotherapy,  we  may  divide 
them  into  the  rest  and  the  ambulatory  stages.  For  the  sake  of  clear- 
ness, the  author  will  describe  the  daily  treatment  of  such  a  case.  The 
patient,  in  bed  with  proper  diet  and  surroundings,  receives  immedi- 
ately after  breakfast  an  application  of  the  galvanic  current.  Two 
hours  later  the  ice-bag  is  applied  over  the  heart  for  twenty  to  thirty 
minutes,  ever  the  thyroid  gland  for  twenty  minutes ;  dinner  in  the 
middle  of  the  day,  followed  by  a  second  treatment  by  galvanism, 
three  hours  later  very  gentle  massage  is  administered,  followed  by 
the  application  of  the  ice-bag  to  the  heart  and  thyroid  gland;  supper 
is  eaten  and  at  bedtime  the  ice-bag  is  again  applied  over  the  heart 
and  gland.  At  the  end  of  approximately  three  to  four  weeks  we 
commence  the  use  of  the  dripping  sheet  before  breakfast  at  a  tempera- 
ture of  90°  F.  for  three  minutes,  with  the  patient  standing  in  a  foot- 
tub  of  hot  water;  be  sure  to  secure  satisfactory  reaction.  At  the  start 
the  circulation  may  be  somewhat  perturbed,  but  this  subsides  in  a 
few  days,  especially  when  the  temperature  of  the  sheet,  which  is  re- 
duced two  degrees  daily  to  65°  F.,  reaches  the  colder  temperatures. 
Some  time  during  the  day  the  physician  should  administer  the  lighter 
and  simpler  movements  of  the  Schott  system  of  graduated  exercises. 
After  about  five  or  six  weeks  the  patient  begins  to  get  up  for  short 
periods  during  the  day,  which  are  gradually  lengthened.  At  the  end 
of  about  eight  weeks  the  patient  is  able  to  take  full  and  complete 
treatment. 


FUNCTIONAL  NERVOUS  DISEASES.  383 

Full  treatment  in  these  cases  consists  in  the  application  of  the  gal- 
vanic current,  usually  after  breakfast,  and  the  admintration  of  the 
hydrotherapeutic  prescription  at  about  ten  or  eleven  o'clock.  Electric 
light  bath  so  that  the  patient  barely  perspires ;  horizontal  rain  bath  at 
a  temperature  of  100°  F.  for  one  and  one-half  minutes,  pressure  fif- 
teen pounds,  reduced  to  65°  F.  for  ten  seconds,  this  in  turn  being  fol- 
lowed by  the  jet  douche  to  the  spine  and  legs  at  the  same  pressure 
and  temperature,  for  ten  seconds.  The  douche  is  kept  rapidly  moving. 
The  pressure  should  be  gradually  and  daily  increased  until  thirty  to 
thirty-five  pounds  is  reached.  Reaction  having  been  secured,  the 
patient  retiies  to  bed,  and  an  ice-bag  is  placed  over  the  heart  and  thy- 
roid gland  as  heretofore,  remaining  in  bed  until  dinner  time.  During 
the  afternoon  general  massage  is  given,  followed  by  the  ice-bag;  after 
supper  static  electricity,  and  finally,  at  bedtime,  the  ice-bag  again. 
Where  improvement  continues  this  treatment  is  kept  up  for  several 
months,  galvanism,  ice-bag,  massage  and  hydrotherapy  being  gradu- 
ally withdrawn  in  the  order  named.  Coincident  with  this,  the  patient 
is  allowed  to  drive  out,  take  short  walks  and  gradually  resume  her 
place  in  the  social  world. 

There  are,  however,  some  cases  that  do  not  do  well  under  the  use 
of  the  horizontal  rain  bath  and  douche,  and  these  are  best  met  by 
the  Nauheim  or  carbon  dioxide  bath  treatment.  The  preliminary 
period  of  such  treatment  will  oftentimes  enable  the  physician  to  em- 
ploy the  douche.  The  author  has  found  Dana's  method  of  using  gal- 
vanism be?t.  Climate  and  mineral  waters  possess  no  value  as  thera- 
peutic agents.  Should  these  cases  go  to  the  sea-shore,  even  after 
complete  recovery,  they  should  never  indulge  in  surf-bathing,  as  it  is 
too  violent.  Many  writers  have  advised  the  use  of  the  full  wet  pack 
as  preferable  to  the  douche,  but  this  has  not  been  the  author's  experi- 
ence. Patients  are  finally  cautioned  never  to  allow  themselves  to  "run 
down,"  and  where  they  notice  a  recurrence  of  any  of  the  prominent 
symptoms  to  immediately  return  for  a  six  to  eight  weeks'  course  of 
treatment.  The  author  has  had  half  a  dozen  cases  to  so  relapse  and 
immediately  improve  on  the  institution  of  the  treatment  along  the  lines 
already  laid  down. 

Headache. 

If  printer's  ink  is  to  be  taken  as  the  criterion  of  the  needs  of  a 
country  or  community,  if  its  extent  and  persistency  are  any  indication 
as  to  the  wants  of  the  inhabitants,  then  certainly  there  is  to-day  among 
the  people  of  America  abundant  evidence  of  the  prevalence  and  per- 
sistence of  cranial  pain.  Wherever  we  turn  and  wherever  we  go, 
we  are  confronted  with  the  glaring  poster  or  colored  card,  indicating 
to  the  passing  eye  the  relief  of  a  symptom  that  must  be  so  common 
and  so  frequent  as  to  have  impressed  its  importance  and  its  needs 


384  PRACTICAL  HYDROTHERAPY. 

upon  the  superficial  and  casual  observance  of  the  populace.  From 
another  standpoint  it  evidences  a  certain  futility  in  the  medication  of 
head  pains. 

In  organic  headaches  the  therapeutic  field  is  of  necessity  much 
narrowed,  and  the  results  obtained  are  usually  unsatisfactory  and 
more  or  less  euthanasic.  Generally  speaking,  the  organic  head- 
ache is  constant,  with  variations  from  slight  to  extreme  and  severe 
paroxysms,  the  pain  rarely  intermits,  and  becomes  so  prominent  as 
to  prevent  sleep. 

Meningeal  headache  may  occur  in  two  forms — the  acute,  or  that 
form  present  during  the  acute  inflammatory  stages  of  the  disease, 
and  a  chronic  headache  brought  about  by  the  changed  or  thickened 
condition  of  the  meninges.  In  the  acute  headache  we  must  at  once, 
and  as  far  as  possible,  remove  all  causal  agents  and  adjacent  foci  of 
irritation,  secure  absolute  quiet  in  a  darkened  room,  and  nutritious 
liquid  food  without  stimulants.  The  hair  is  to  be  cut  close,  and  an 
ice-bag,  coil-cap  or  Leiter's  tubes  made  use  of  while  we  are  admin- 
istering such  medicinal  treatment  as  is  demanded  by  the  case.  In 
ihe  chronic  form  medicines  seem  to  be  totally  without  value,  with 
possibly  the  exception  of  iodide  of  potash,  and  in  this  condition  relief 
is  best  obtained  by  the  use  of  hydrotherapy. 

Traumatic  headache,  or  head  pain  occurring  after  blows,  concus- 
sions, after  laceration  of  the  brain  substance,  and  after  surgical  ope- 
rations, is  usually  severe  and  lasts  a  long  time.  It  need  not  be  circum- 
scribed or  limited  to  a  region  corresponding  to  the  site  of  the  injury, 
but  in  my  experience  it  has  rather  tended  to  be  diffuse  than  circum- 
scribed. Prominently  associated  with  headache  are  vertigo,  lassitude 
and  indisposition  to  mental  effort.  After  a  little  while  the  head  struc- 
ture seems  to  take  on  a  sensitive  state  and  become  appreciative  of 
very  slight  causes  that  are  provocative  of  pain.  Of  all  organic  head- 
aches that  I  have  to  treat,  this  form  has  yielded  the  best 
results. 

Arterio- sclerotic  headaches,  occurring  in  the  early  stages  of  the 
disease,  can  be.  as  a  rule,  very  materially  benefited  and  influenced 
by  the  treatment  suggested  for  this  disease.  These  headaches  are 
produced  by  changes  in  the  walls  of  the  small  vessels  (endarteritis), 
are  influenced  by  soluble  and  diffusible  poisons  circulating  through  the 
structures  that  are  aching;  later  the  headaches  are  accentuated  by 
the  gradual  closure  of  the  small  vessels. 

Functional  headache  is  really  one  of  the  commonest  ailments  to 
which  the  American  of  to-day  is  subject,  and  it  spares  neither  man, 
woman  nor  child,  but  occurs  in  twice  as  great  frequency  in  the  female. 
Probably  owing  to  the  high  pressure  under  which  the  urbanite  lives, 
together  with  the  fact  that  he  is  closely  confined  in  illy-lighted  and 
poorly-ventilated  rooms,  we  find  that  he  suffers  much  more  frequently 


FUNCTIONAL  NERVOUS  DISEASES.  385 

than  the  suburbanite  who  tills  the  soil  and  lives  in  freer  and  purer 
atmosphere. 

The  duiation  of  headaches  is  as  variable  as  the  winds  themselves, 
ranging  from  a  few  hours  to  many  years.  There  are  very  few  indi- 
viduals that  escape  headache  during  their  lifetime;  many  only  suffer 
when  "bilious,"  or  when  the  alimentary  canal  has  become  clogged  and 
inactive.  The  pain  may  be  continuous  or  paroxysmal.  The  pain  of 
headache  is  nearly  always  diffuse,  and  is  generally  described  as  being 
deep-seated ;  the  pain  is  probably  caused  by  irritations  located  or  re- 
ferred to  the  peripheral  ends  of  the  fifth  or  twelfth  nerves,  whose 
terminations  are  found  in  the  dura  mater. 

It  is  largely  through  the  blood-vascular  system  that  we  have 
to  look  for  the  changes  that  are  productive  of  this  disorder, 
and  it  is  probable  that  the  excellent  results  achieved  by  the  use 
of  hydrotherapeutical  remedies  have  been  due  to  the  fact  that  they 
act  largely  through  this  system,  and  favor  elimination,  purification 
and  reconstruction  of  the  vital  circulating  fluid.  Poisons  circulating  in 
the  blood,  elaborated  during  the  growth  of  pathogenic  micro-organ- 
isms, many  of  which  we  are  unacquainted  with;  that  group  of  toxic 
products  developed  in  the  many  and  multiple  changes  that  occur  dur- 
ing the  chemism  of  tissue  metabolism ;  imperfect  retrograde  changes, 
not  eliminated,  but  retained  through  imperfect  excretion— all  may 
act  in  producing  cranial  pain.  These  cases  usually  refuse  to  yield  to 
symptomatic  or  medicinal  treatment,  but  yield  brilliant  results  to  hydro- 
therapy. 

Sometimes  the  mere  removal  of  the  cause  of  the  headache  is 
far  from  sufficient,  although  we  are  so  taught  by  many  authori- 
ties that  the  removal  of  the  cause  is  all  that  is  necessary  to  produce 
a  satisfactory  cure  of  the  case.  It  is  a  beautiful  theory  but  far  from 
the  facts  of  practice.  He  who  is  gifted  with  the  ability  to  discern  and 
remove  the  causal  factors  has  found  to  his  sorrow  that  it  does  not  re- 
lieve, for  it  seems  that  certain  "habits  of  pain"  become  established, 
become  points  of  least  resistance,  are  easily  upset  by  any  slight  cause 
or  causes  acting  upon  these  structures.  I  would  say  that  in  laying 
down  the  general  routine  of  treatment  of  all  functional  headaches, 
we  should  proceed  as  follows : 

By  a  careful,  painstaking  examination  and  analysis  arrive,  if  pos- 
sible, at  the  causal  features,  which  we  will  proceed,  of  course,  to  cor- 
rect. Then  remove  any  and  all  burdens  that  might,  through  their 
transferred  or  reflex  action,  increase  or  accentuate  the  local  symptoms, 
such  burdens  being  prominently  found  in  the  eye,  the  gastrointestinal 
tract,  the  uterus,  etc.  Next  regulate  the  hygienic  surroundings  of  the 
patient,  attending  with  especial  care  to  the  cloaca  maxima ;  remove 
such  toxic  problems  as  tobacco,  alcohol,  coffee  or  tea;  regulate  work; 
prevent  overwork;  enjoin  a  proper  dietary,  sufficient  exercise,  and,  as 


386  PRACTICAL  HYDROTHERAPY. 

far  as  possible,  such  mental  treatment  as  will  tend  to  prevent  constant 
recollection  of  the  pain. 

As  a  rule,  the  hydriatist  never  sees  a  case  of  headache  until  it  has 
become  chronically  fixed  and  the  patient  has  "tried"'  a  number  of 
physicians  and  a  multitude  of  remedies,  adopting  them  in  a  hit-or-miss 
fashion,  or  "in  hopes  of  its  doing  him  some  good";  so  it  is  always 
well  to  remind  such  cases  that  chronic  headaches  require  more  or  less 
chronic  treatment. 

The  treatment  of  headache  should  be  along  two  lines — the  meet- 
ing of  the  causal  indications  and  localized  conditions  that  exist  in  the 
case,  and  up-building  of  the  general  nerve  and  nutritional  state  of  the 
patient.  Careful  and  persistent  regulation  of  the  cloaca  maxima  is 
the  rule  practically  in  all  cases,  the  treatment  of  which  has  been  dwelt 
upon   heretofore    (see  Constipation). 

It  has  always  appeared  to  the  author  that  there  is  a  reasonable 
and  rational  explanation  of  why  in  headaches  hydrotherapy  should  be 
superior  to  any  method.  Headaches  being  produced  largely  through 
the  instrumentality  of  the  blood  circulation,  any  method  that  can 
control  this  activity,  favor  elimination  and  produce  changes  in  metab- 
olism, is  an  agent  for  vast  good.  No  remedy  that  the  author  is  aware 
of  so  thoroughly  and  perfectly  meets  the  requirements  as  hydrother- 
apy, and  he  has  for  a  long  number  of  years  depended  largely  upon 
it  for  the  relief  of  head  pain. 

The  general  or  nutritional  treatment  of  headache  should  have  for 
its  object  the  toning  or  "equalizing"  of  the  circulation ;  increased  oxy- 
genation ;  elimination  of  toxins  and  the  waste  products  of  metabo- 
lism ;  the  elevation  of  depreciated  nervous  tone ;  the  increase  of  neural 
strength ;  the  absorption  of  any  existing  inflammation ;  the  betterment 
of  the  appetite,  digestion  and  assimilation ;  and  in  hydrotherapy  we 
find  a  single  measure  fitted  to  accomplish  the  entire  work.  These 
cases  are,  as  a  rule,  never  confined  to  bed,  and  for  that  reason  we  may 
start  with  a  rather  full  treatment.  In  weak,  delicate  and  anemic  pa- 
tients commence  by  giving  the  electric  light  bath  or  the  hot-air  bath 
until  the  surface  of  the  body  is  thoroughly  warm,  and  before  perspira- 
tion takes  place  remove  from  the  bath  and  give  either  a  rapid  cold 
sponge  at  70°  F.  or  the  dripping  sheet  at  80°  F.  for  three  minutes, 
with  vigorous  friction,  reduced  two  degrees  daily  to  70°  F.  If  the 
case,  however,  is  fairly  strong,  we  may  use  the  electric  light  bath 
until  perspiration  takes  place  or  until  the  skin  surface  is  well  warmed. 
If  it  is  desired  to  put  on  flesh  the  patient  should  be  allowed  to  per- 
spire but  slightly.  Upon  removal  from  this  bath  we  give  the  hori- 
zontal or  circular  rain  bath  at  100°  to  104°  F.  for  one  or  two  minutes, 
twenty  pounds  pressure,  reduced  to  80°  for  one-fourth  minute,  fol- 
lowed by  a  rapid  drying  and  sufficient  friction  to  secure  a  good  reac- 
tion.    Reduce  the  temperature  two  degrees  daily  to  65°  F.  and  in- 


FUNCTIONAL  NERVOUS  DISEASES.  387 

crease  the  pressure  one  pound  daily  until  thirty  pounds  is  reached. 
Patients,  as  a  rule,  begin  to  show  improvement  after  ten  to  fifteen 
treatments.  The  aim,  however,  is  to  reach  the  higher  stimulation  that 
is  obtained  by  the  application  of  the  jet  douche,  and  as  soon  as  im- 
provement takes  place  and  reaction  is  well  established  give  the  fol- 
lowing treatment :  Electric  light  bath  until  moderate  perspiration ; 
rain  bath  at  100°  to  104°  F.  for  one  and  a  half  minutes,  thirty  pounds 
pressure ;  reduced  to  65°  F.  for  one- fourth  minute,  followed  by  spray 
or  fan  douche  at  65°  F.,  twenty  pounds  pressure,  to  the  body  for 
ten  seconds  and  the  jet  douche  to  the  spine  and  posterior  aspect  of  the 
lower  limbs  for  ten  seconds,  paying  especial  attention  to  the  cervical 
region,  and  being  careful  to  terminate  the  jet  on  the  lower  spine  and 
limbs.  The  effect  of  such  treatment  is  far-reaching  and  satisfactory; 
all  the  secretions  and  excretions  are  stimulated,  and  under  its  influ- 
ence tissue  change  takes  place.  The  functional  activity  of  those  or- 
gans that  have  been  threatened  and  crippled  are  given  a  physiological 
lift,  as  it  were,  and  through  the  lightening  of  the  burden  resume  their 
former  proper  action,  with  the  result  that  permanent  improvement  is 
obtained.  The  nervous  system  is  much  impressed,  owing  to  the  mani- 
fold reflex  effects  that  arise  from  the  thermic  irritation. 

Certain  forms  of  headache  demand  special  treatment.  The  local- 
ized treatment  of  nearly  all  headaches,  especially  those  due  to  troubles 
arising  from  the  eye,  ear,  nose,  throat  or  teeth,  and  the  supraorbital, 
temporal  and  cervico-occipital,  are  best  met  by  the  application  of  the 
fomentation  over  the  painful  parts,  followed  by  the  cephalic  compress, 
the  use  of  the  hot  foot-bath,  the  half  pack  at  120°  F.  for  one  hour, 
or  the  warm  full  bath  at  100°  F.   for  twenty  minutes. 

Anemic  headaches  may  oftentimes  be  relieved  by  applying  the 
cephalic  compress  wrung  out  of  water  at  120°  to  130°  F.,  or  by  the 
application  of  the  fomentation  at  the  same  temperature  to  the  painful 
part.  At  the  same  time  the  Chapman's  double-column  hot-water  bag 
may  be  applied  to  the  neck  or  over  the  cervical  cord,  the  patient  re- 
clining in  bed  with  the  head  low.  The  general  treatment  is  valuable 
in  these  cases,  and  at  the  same  time  must  be  borne  in  mind  the  treat- 
ment for  anemia. 

Hypercmic  headaches  require  rest,  elevation  of  the  head  and  shoul- 
ders, and  heat  to  the  extremities.  The  very  hot  foot-bath  or  the  half 
pack  at  temperature  of  65°  F.  for  one  hour,  together  with  the  applica- 
tion of  the  cephalic  compress  at  a  temperature  of  60°  F.,  repeated  as 
often  as  it  becomes  hot,  or  the  coil-cap  or  ice-bag  over  the  cephalic 
compress.  Sometimes  the  throat  compress,  in  addition  to  the  bath, 
will  give  prompt  relief.  In  these  cases  the  Scottish  or  alternating 
douche  to  the  spine  and  legs  is  most  excellent. 

Toxic  headaches,  where  due  to  tobacco,  alcohol,  tea,  coffee  or  other 
poisons,  demand  first  cessation  of  the  intake ;  profuse  sweating  meas- 


388  PRACTICAL  HYDROTHERAPY. 

u res,  followed  by  a  general  cold  tonic  treatment,  especially  the  douche. 
Copious  drinks  of  pure,  alkaline  or  carbonated  waters,  to  which,  if 
lead  is  the  cause  of  the  headache,  the  iodides  may  be  added  in  small 
doses.  The  same  treatment  is  advisable  where  the  headaches  are 
caused  by  an  excess  of  acids,  oxalates,  urea,  purin  bodies,  or  any 
waste  material  due  to  decomposition  and  absorbed  from  the  alimen- 
tary canal  or  thrown  into  the  circulation  through  defective  metabo- 
lism. Where  the  toxic  headache  is  due  to  derangement  in  the  stom- 
ach, intestine  or  colon,  gastric  lavage  to  cleanse  the  stomach  of  foul 
or  fermenting  food,  followed  by  antiseptic  irrigation,  the  mode- 
rate use  of  the  enema  and  the  treatment  of  constipation,  in  addi- 
tion to  the  general  management,  will  prove  effective.  Where  marked 
atony  or  splanchnoptosis  is  present,  the  abdominal  supporter,  the  ab- 
dominal pack  at  65°  F.  for  several  hours,  Neptune's  girdle  worn 
during  the  night,  abdominal  massage,  the  sinusoidal  current  to  the 
abdominal  muscles  and  the  Scottish  or  alternating  douche  to  the  spine 
and  the  abdominal  wall,  will  in  many  instances  bring  about  recovery. 

Reflex  headaches,  dependent  upon  ocular,  nasal,  auditory,  pelvic, 
sexual  or  other  irritations,  demand  the  removal  of  the  cause  and  such 
local  treatment  as  the  individual  condition  indicates,  with  the  general 
nutritional  treatment  above  outlined. 

Neuropathic  headaelies  arising  in  the  course  of  neurasthenia,  hys- 
teria, epilepsy,  neuritis  and  other  affections,  demand  no  special  treat- 
ment save  that  of  the  disease  itself,  which  has  been  thoroughly  consid- 
ered under  the  sections  named. 

Organic  headaches,  where  due  to  arterio-sclerosis,  syphilis,  menin- 
gitis and  other  causes,  should  be  treated  as  indicated  under  the  par- 
ticular disease  acting  as  the  causal  agent.  These  headaches  are  often- 
times modified  by  the  application  of  the  very  hot  compress  to  the 
head  over  the  painful  part,  followed  by  the  cephalic  cempress.  This 
treatment  may  be  repeated  every  two  or  three  hours  until  relief  is 
given. 

In  like  manner  the  diathetic  states  of  gout,  rheumatism,  diabetes, 
uremia,  must  be  met  by  measures  calculated  to  relieve  the  disease 
itself. 

In  all  cases  of  headache  rest  is  found  to  be  advisable,  not  only  dur- 
ing the  attack,  but  in  the  interparoxysmal  period.  It  should  form  a 
part  of  every  plan.  Certain  medicines  can  be  used  for  temporary  re- 
lief, although  they  have  no  curative  or  permanent  value,  among  which 
may  be  mentioned  the  bromides,  gelsemium,  cannabis  indica,  caffeine, 
phenacetine,  etc. 

Migraine. 

Migraine,  hemicrania,  sick  or  nervous  headache,  is  a  neurosis 
whose  most  characteristic  symptom  is  a  paroxysmal  headache,  usually 


FUNCTIONAL  NERVOUS  DISEASES.  389 

confined  to  one-half  of  the  head  in  the  region  of  the  fifth  nerve.  The 
attack  of  pain  or  ache  is  usually  closely  associated  with  mental  de- 
pression, nausea,  vomiting,  intolerance  of  light,  sensitiveness  to  sound, 
vertigo,  pallor  and  flushing  of  the  face,  tinnitus  aurium,  incapability  of 
mental  action,  and  some  prostration.  It  is  a  very  frequent  disease, 
occurring  more  often  in  women  and  developing  usually  about  the 
period  of  puberty.  It  excepts  no  profession  or  calling,  but  selects 
its  sufferers  from  all  walks  of  life.  The  wage-earner,  the  brain- 
worker,  the  scientist,  the  statesman  and  physician  are  not  spared.  It 
occurs  in  neurotic  families,  and  seems  to  bear  a  close  relationship  to 
epilepsy ;  in  fact,  some  authors  are  inclined  to  believe  that  this  is 
likewise  a  degenerative  neurosis.  The  exciting  causes  are  usually  those 
of  overwork,  both  bodily  and  mental,  loss  of  sleep,  shock  and  trauma, 
digestive  disorders,  acute  auto-toxemia,  etc.  Continuous  poisoning 
from  the  digestive  tiact  and  refractive  disorders  of  the  eye  are  often 
agents  that  tend  to  keep  up  as  well  as  bring  on  attacks.  The  attacks 
are  irregular  and  occur  most  frequently  in  winter.  They  usually  last 
from  six  to  twenty-four  hours,  sometimes  two  or  three  days.  The 
disease  seems  to  lessen  after  the  fourth  decade,  both  in  men  and 
women,  especially  so  in  the  latter  after  the  menopause.  It  may  some- 
times be  associated  with  epilepsy  and  various  other  neural  manifesta- 
tions. Its  pathology  is  that  of  a  fulminating  neurosis,  with  periodical 
nerve  storms  occurring  along  the  intracranial  branches  of  the  fifth 
and  pneumogastric  nerves,  without  anatomical  basis,  its  seat  being 
probably  the  cerebral  cortex,  the  attacks  being  precipitated  by  some 
auto-toxic  agent. 

Treatment  resolves  itself  into  that  of  the  attack  and  the  inter- 
paroxysmal  period.  When  called  to  see  a  case  of  migraine  it  will 
generally  be  found  that  the  patient  has  voluntarily  sought  rest  and 
quiet  in  a  darkened  room,  as  far  as  possible  from  noise  and  inter- 
ruption. We  should  forbid  at  once  any  food  whatever  during  the  ex- 
istence of  the  attack,  and  proceed  to  use  lavage,  washing  the  stomach 
out  thoroughly  with  plain  warm  water  or  warm  saline  and  finishing 
the  wash  by  leaving  within  the  stomach  a  dose  of  an  alkaline  cathar- 
tic. Sometimes  it  is  necessary  to  precede  or  follow  this  by  a  hot  soap- 
suds enema,  though  in  a  great  many  cases  this  is  not  necessary.  The 
patient  should  be  urged  to  drink  freely  and  frequently  some  carbon- 
ated water,  the  most  satisfactory  of  which  is  Vichy  or  seltzer  in 
glass  syphons.  Much  relief  and  abatement  of  pain  will  be  secured 
from  a  hot  foot-bath  for  ten  or  fifteen  minutes,  commencing  with  a 
temperature  of  104°  or  105°  F.  and  rapidly  adding  hot  water  until 
115°  to  125°  F.  has  been  attained,  administered  with  the  patient  reclin- 
ing across  the  bed.  This  is  to  be  followed  by  a  fomentation  to  the  head 
over  the  seat  of  pain,  applying  same  as  hot  as  can  be  borne  for  a  period 
of  ten  minutes,  followed  by  a  compress  or  ice-bag  to  the  affected  re- 


390  PRACTICAL  HYDROTHERAPY. 

gion.  In  conjunction  with  this  we  may  administer  certain  coal-tar 
preparations  where  the  pain  is  severe. 

The  treatment  of  the  interval  has  for  its  object  the  upbuilding  of 
nerve  tone,  general  health,  and  the  maintenance  of  nutrition,  removing 
all  causes,  be  they  auto-toxic  or  reflex.  With  this  in  view  we  should 
correct  visual  disorders  under  cycloplegia;  remove  nose  and  ear  ab- 
normalities ;  correct  uterine,  ovarian  and  stomach  disorders,  with  the 
distinct  idea  in  view  of  relieving  the  burden  of  their  existence  upon 
the  already  handicapped  patient.  Children  in  whose  families  migraine 
runs  should  have  their  eyes  examined  before  the  development  of  the 
disease.  Careful  regulation  of  the  diet  with  the  object  of  preventing 
putrefaction  and  the  formation  of  purins,  toxins,  etc.,  is  best  accom- 
plished by  avoiding  tea,  coffee,  tobacco,  alcohol  and  malt  liquors,  and 
eating  red  meats  in  small  quantities.  Green  vegetables,  cooked  cereals, 
dry  bread,  potatoes,  beans,  corn,  peas,  tomatoes,  asparagus,  spinach, 
lettuce,  eggs,  fish  and  fowl  form  a  good  dietary,  for  the  digestion 
must  be  such  as  to  maintain  nutrition  and  prevent  toxemia.  The 
writer  is  of  the  opinion  that  too  great  care  cannot  be  exercised  to 
overcome  the  existing  constipation,  and  to  this  end  the  treatment  here- 
tofore mentioned  should  be  used,  embracing  hydrotherapy,  massage 
and  the  sinusoidal  current.  Salines  must  be  avoided,  as  they  deplete 
the  system  and  by  their  too  free  osmosis  interfere  with  nutrition. 
Equanimity  of  mind,  the  avoidance  of  mental  and  physical  strain,  the 
constant  practice  to  secure  an  even  disposition,  the  leading  of  a  quiet 
and  regular  life,  the  avoidance  of  anxiety,  worry,  late  hours,  crowded 
rooms,  and  all  excesses,  will  go  a  long  way  toward  preventing  the 
recurrence  of  attacks.  Daily  exercise  of  from  one  to  two  hours  in 
the  open  air,  walking,  golfing,  bicycling  or  driving,  is  advantageous. 
These  cases  should  secure  nine  to  ten  hours'  sleep  nightly.  Climate 
is  of  no  value,  and  treatment  is  too  frequently  neglected,  although 
it  deserves  the  same  care  and  thoughtfulness  as  the  other  severe  neu- 
roses. Children  of  migrainous  parents  should  have  their  health  kept 
perfect,  their  education  carefully  arranged  to  prevent  over-strain,  and 
otherwise  reared  as  the  neurotic  child  should  be.  Hydrotherapy  pos- 
sesses great  value  in  these  cases,  because  its  action  is  to  increase  vital- 
ity and  neural  force,  favor  elimination,  prevent  attacks,  and  by  its  ad- 
mirable tonic  and  reflex  action  upon  the  vasomotor  centers  and  nerves 
prevent  many  of  the  conditions  that  incite  and  perpetuate  the  attacks 
as  well  as  the  disease  itself. 

A  plan  suitable  for  the  home  or  for  those  whose  reaction  is  poor 
would  be  the  following:  Dry  pack  for  half  to  one  hour,  followed  by 
a  cold  sponge  with  water  at  a  temperature  of  70°  F.  After  a  few 
days  of  this  treatment  give  the  dry  full  pack  for  thirty  minutes,  fol- 
lowed by  the  dripping  sheet  at  70°  F.  for  three  minutes,  with  vigor- 
ous friction.     As  soon  as  this  point  is  reached  dispense  with  the  dry 


FUNCTIONAL  NERVOUS  DISEASES.  391 

pack  and  give  the  dripping  sheet  at  65°  F.  for  three  minutes,  with 
good  friction,  while  the  patient  stands  in  a  foot-tub  of  water  as  hot 
as  can  be  borne.  Reaction  must  be  secured.  This  treatment  is  gen- 
erally administered  in  the  morning,  and  when  this  time  is  selected, 
give  the  general  wet  pack  at  65°  F.  for  one  hour  at  bedtime.  When 
the  patient  is  removed  from  the  pack  he  is  rapidly  dried  and  no  reac- 
tion is  sought.  The  advantage  of  this  method  of  treatment  is  to 
obtain  the  stimulating  and  tonic  influences  of  the  dripping  sheet  in 
the  morning  and  the  sedative  and  sleep-producing  effects  of  the  wet 
pack  at  bedtime. 

Another  good  method  is  to  have  the  patient  at  first  sit  in  a  half 
bath  with  water  at  102°  to  104°  F.,  while  the  attendant  gives  him  an 
affusion  at  80°  F.  to  the  spine,  back  and  chest.  Reduce  temperature 
five  degrees  daily  to  65°  F.  At  this  point  the  patient  should  stand  in 
the  tub  in  water  as  hot  as  can  be  borne,  while  the  affusion  is  given 
to  the  entire  body  or  the  water  is  thrown  with  force  against  the  body 
from  a  large  dipper.  This  may  be  further  modified  by  first  im- 
mersing the  body  in  warm  water,  then  giving  a  salt  rub  or  glow  fol- 
lowed by  the  affusion.  The  warm  full  bath  at  104°  to  105°  F.  for 
five  or  seven  minutes,  followed  by  the  salt  rub  and  finally  by  the 
cold  showei  at  70°  to  65°  F.,  will  be  found  useful.  Reaction  is  es- 
sential. 

As  vital  processes  are  most  powerfully  influenced  by  the  douche, 
and  as  these  cases  are,  as  a  rule,  up  and  going  about,  we  may.  after 
laying  down  the  laws  by  which  they  are  to  govern  their  life,  and 
insisting  upon  free  water-drinking,  commence  a  course  of  hydro- 
therapeutics  with  the  administration  of  some  sweating  procedure, 
the  best  by  far  of  which  is  the  electric  light  bath  until  free  perspi- 
ration takes  place,  followed  by  a  horizontal  or  circular  rain  bath  at 
a  temperature  of  104°  F.  for  two  minutes,  reduced  to  70°  F.  for  one- 
fourth  minute,  reducing  the  temperature  two  degrees  daily  until  60° 
F.  is  reached.  At  this  point  we  should  add  the  jet  douche  to  the 
above  treatment  at  a  temperature  of  60°  F.  for  five  or  ten  seconds 
to  the  spine  and  posterior  aspect  of  the  legs.  In  robust  persons  the 
author  has  found  the  following  excellent:  Electric  light  bath  until 
free  perspiration;  horizontal  or  circular  rain  bath,  temperature  104° 
F.  for  one  minute,  followed  by  the  jet  douche  to  the  spine  and  legs 
at  110°  F.,  gradually  increasing  to  115°  to  120°  F.  for  one-half 
to  one  minute,  rapidly  reduced  to  60°  F.  for  five  to  ten  seconds,  ap- 
plied to  the  spine  and  posterior  part  of  the  legs  only.  In  some 
cases  it  will  be  found  that  the  neutral  bath  at  a  temperature  of  94° 
to  96°  F.  for  twenty  to  sixty  minutes  will  oftentimes  prove  of  service, 
and  will  sometimes  prevent  the  occurrence  of  the  attack  that  is 
threatened,  although  the  author's  experience  has  been  that  should 
an  intimation  of  the  attack  be  present  it  is  wisest  to  institute  at  once 


392  PRACTICAL  HYDROTHERAPY. 

the  methods  suggested  for  the  treatment  of  the  attack  itself.  By 
this  method  of  management  migraine  has  been  successfully  cured, 
provided  the  treatment  was  kept  up  for  several  months. 

Insomnia. 

The  necessity  for  sleep,  and  the  intimate  and  important  relation 
it  bears  to  the  preservation  of  health  and  even  life  itself,  surround 
the  study  of  its  phenomena,  in  health  and  disease,  with  an  interest 
second  to  nothing  that  I  can  recall.  For  ages  philosophers,  physiolo- 
gists and  clinicians  have  vied  with  one  another  in  endeavoring  to 
solve  its  intricate  problems,  and  to-day  in  insomnia  we  are  confronted 
with  a  condition  that  begins  to  assume  gigantic  proportions. 

The  ever-growing  importance  of  a  knowledge  of  how  to  preserve 
normal,  healthy  sleep,  and  how  to  relieve  sleeplessness,  becomes  ap- 
parent to  the  most  superficial  of  observers.  Our  daily  life  is  one  of 
wear  and  tear,  whether  it  be  at  the  desk  or  in  the  counting-house,  be- 
fore the  bar  of  justice  or  at  the  bedside,  upon  some  pleasure  expedi- 
tion or  in  arduous  toil.  A  glance  at  a  Rubens,  a  Raphael  or  a  Venus 
de  Milo  consumes  our  cerebral  force,  and  not  a  second  of  the  time 
is  the  brain  inactive  while  awake.  Thus  every  act  or  thought,  every 
object  viewed,  every  sound  heard,  is  a  tax  upon  the  nervous  system. 

Work  calls  in  turn  for  repose.  The  nervous  system  rests  only  dur- 
ing sleep,  and  it  needs  no  further  demonstration  that  sound  and 
healthful  sleep  is  essential  to  the  well-being  of  every  individual.  The 
more  we  work  the  greater  the  need  of  sleep.  The  mind  can  resist  the 
need  of  sleep  only  up  to  a  certain  point.  Soldiers  fall  asleep  in  the 
saddle,  and  the  writer  remembers  his  total  inability  to  resist  the  sleepy 
feeling  stealing  over  him  on  a  long  and  trying  ride  in  Colorado — 
in  fact,  does  not  remember  anything  that  occurred  during  the  last 
few  miles  of  the  ride. 

Sleep  is  usually  brought  about  by  a  diminution  of  irritability  caused 
by  fatigue  of  a  large  area  of  the  cerebral  cortex.  In  addition,  owing 
to  relaxation  of  the  vasomotor  tone,  lowering  of  arterial  blood-pres- 
sure, and  lessened  demand,  less  blood  is  sent  to  the  brain.  There  is 
present  a  cyclic  tendency  to  rest,  and  this  is  aided  by  the  voluntary 
withdrawal  of  physical,  sensory  and  mental  stimuli  involved  in  goin.^ 
to  bed.  This  condition  is  favorable  for  the  repair  of  brain  tissue. 
The  full  and  true  mechanism  of  sleep  is  not  yet  understood. 

The  respiration  and  heart-beat  are  slower,  due  to  lessened  medul- 
lary innervation.  The  salivary,  urinary  and  conjunctival  secretions 
are  less  active.  The  special  senses  of  sight,  taste,  smell,  hearing  and 
touch  are  lost. 

The  onset  of  sleep  is  gradual ;  a  delicious  feeling  of  languor,  a 
drooping  of  the  eyelid,  the  unsocial  but  truth-telling  yawn,  are  the 
pleasant  forerunners  of  approaching  sleep.     Upon  retiring,  in  a  short 


FUNCTIONAL  NERVOUS  DISEASES.  393 

time  we  experience  a  feeling  of  inward  supineness,  enervation  and 
torpor;  the  limbs,  head  and  back  partake  of  this  general  feeling,  and 
assume  a  position  of   relaxation  and  comfort. 

The  physical  phenomena  of  sleep  are  many.  The  sensorium,  both 
special  and  common,  becomes  incapable  of  recognizing  external  im- 
pressions. That  most  wonderful  attribute,  the  will,  is  abolished; 
judgment,  reason  and  perception  are  greatly  weakened,  while  the 
emotions  and  imagination  are  retained — memory  only  partially.  The 
nervous  s\stem  is  quiescent,  its  many  and  diverse  functions  curtailed; 
reflex  action  less  active,  and  the  medullary  centers  of  respiration 
and   circulation  slackened. 

Thus  the  work  of  the  economy  is  carried  on  at  the  lowest  expendi- 
ture of  energy;  its  fires  are  banked,  its  oil-cups  are  shut  off,  its 
machinery  still. 

Insomnia  is  a  loss  of  sleep,  either  in  duration  or  depth.  It  is 
a  serious  symptom,  and  should  indicate  to  the  physician  the  necessity 
for  a  careful  inquiry  into  the  patient's  condition.  Insomnia  may  orig- 
inate from  an  incidental  cause,  and  in  its  turn  become  a  cause  of 
grave  diseases  of  the  nervous  system.  There  are  cases  that  contract 
a  habit  of  sleeplessness.  It  is  a  vigilance  in  the  cerebral  cells,  initi- 
ated and  maintained  by  a  perturbing  element.  I  know  of  no  condi- 
tion, unless  it  be  that  of  constant  pain,  that  causes  its  victims  so  much 
misery  as  insomnia.  Sleep  ranks  as  a  co-equal  with  food  in  the  pres- 
ervation of  life,  and  many  a  man's  power  of  work  is  in  proportion 
to  his  ability  to  sleep. 

The  causes  of  insomnia  are  many.  The  aged  are  less  likely  to 
sleep;  the  nervous  temperament,  intellectual  pursuits,  especially  in 
the  evening  or  night;  worry,  anxiety,  fretting  and  bodily  pain  are 
all  potent  causes  in  preventing  sleep.  Some  persons  are  by  heredity 
good  sleepers,  others  bad.  Even  excess  of  light  noises  of  any  kind 
is  unfavorable.  I  know,  however,  of  no  cause  so  potent  for  the  pro- 
duction of  this  symptom  as  overwork.  Constant  strain  and  work 
produce  an  imperfect  vasomotor  innervation,  and  dilatation  of  the 
blood-vessels  follows  upon  the  slightest  provocation.  Neurasthenia 
is  nearly  always  accompanied  by,  and  frequently  causes,  this  trouble. 
Gout,  rheumatism,  lithemia  and  dyspepsia  are  potent  agents.  Anemia 
may  be  a  cause  as  well  as  a  result  of  the  disorder;  while  in  shock, 
hysteria  and  hypochondriasis  this  symptom  is  always  a  prominent  one. 

Toxic  agents,  such  as  the  poisons  of  malaria  and  syphilis,  tobacco, 
cocaine,  alcohol,  chloral  and  morphine,  often  underlie  persistent  and 
intractable  insomnia. 

Reflection  leads  one  to  a  cause  more  potent  than  I  have  mentioned 
previously — the  age  in  which  we  live. 

The  American  is  naturally  a  quick,  active,  nervous  individual,  and 
the  nervou«  diathesis  is  the  prevailing  diathesis  of  this  country.     He 


394  PRACTICAL  HYDROTHERAPY. 

has  a  narrow  margin  of  force,  and  is  always  on  the  edge  of  "nervous 
bankruptcy."  He  is  never  so  happy  as  when  whirled  in  his  "vesti- 
buled  limited"  at  sixty  miles  per  hour.  We  rarely  rest  reasonably, 
and  even  when  taking  recreation  we  feel  we  need  that  wonderful 
factor  in  the  production  of  nervousness — the  daily  press !  Think 
of  the  tax  put  upon  an  already  busy  man  by  being  brought  in  daily 
contact  with  the  actions  of  governments,  at  home  and  abroad,  and 
compelled  to  study  the  fluctuations  of  far-distant  markets ;  the  ex- 
citement incident  to  the  change  of  political  parties ;  the  constant  change 
of  laws  and  new  legislation !  In  the  morning  paper,  read  at  break- 
fast, we  find  the  sorrows  of  the  world,  its  joys  and  its  disappoint- 
ments, and  a,  nature  but  moderately  sympathetic  is  consciously  or  un- 
consciously robbed  of  its  nerve  force  daily,  and  sometimes  twice  daily, 
by  this  indefatigable  power.  Thus  our  mode  of  life  and  civilization, 
the  varied  uses  of  steam  and  electricity,  higher  education  and  scien- 
tific study,  the  excitement  of  religious  revivals  and  of  the  social  ques- 
tion, are  all  contributing  to  make  us  a  nation  of  nervous  people,  and 
wherever  nervousness  is  found  insomnia  invariably  follows  in  its 
wake  like  the  shark. 

In  the  treatment  of  insomnia  hygiene  is  important.  The  room 
should  be  cool  and  contain  plenty  of  fresh  air.  Ventilation  is  best 
secured  from  above ;  noises  and  light  avoided.  The  last  meal  of  the 
day  should  be  taken  at  least  three  hours  before  bedtime.  Diet  should 
be  varied,  nicely  cooked  and  appetizingly  served.  The  clothing  should 
be  light  and  warm.  A  careful  inquiry  into  the  daily  work  and  a  reg- 
ulation of  the  hours  becomes  a  duty.  Rest  during  the  day — a  nap 
after  dinner  of  say  twenty  or  thirty  minutes,  or  simply  reclining  on 
a  sofa — is  beneficial.  Golf,  horseback  riding,  gymnastics,  cycling, 
walking,  lawn-tennis,  bowling — all  have  their  place  and  uses.  Alcohol, 
coffee  and  tobacco  should  be  used  in  extreme  moderation,  or,  what 
is  better,  interdicted  completely.  The  grave  responsibility  of  suggest- 
ing a  sufficient  quantity  of  alcohol  or  malt  liquors  to  produce  sleep, 
and  the  dangers  of  forming  a  habit  from  such  a  prescription,  is  not 
to  be  forgotten.  Morphine  must  never  be  used  for  the  relief  of  in- 
somnia. Hypnotics  are  two-edged  swords,  and  it  has  always  been 
a  question  with  me  whether  the  good  they  do  is  not  offset  by  the  harm 
they  cause. 

It  were  well  for  all  to  remember  that  "no  man  can  gain  time  by 
stealing  it  from  sleep." 

Climate  is  of  some  advantage  in  the  treatment  of  insomnia.  The 
sea-shore  and  long  sea  voyages  have  a  tendency,  by  their  improve- 
ment of  nerve  tone  and  general  restfulness,  to  induce  sleep.  This 
is  true  when  the  voyage  or  stay  at  the  sea-shore  is  not  attended  by 
storms.  The  New  Jersey  coast,  Cape  May  and  Atlantic  City,  are 
the  best.     In  summer  the  Great  Lakes,  Maine,  especially  Kennebunk- 


FUNCTIONAL  NERVOUS  DISEASES.  395 

port,  California,  Bermuda,  Egypt,  etc.,  bear  excellent  reputations. 
Warm  milk  or  infant's  food  at  bedtime  is  valuable.  The  ideal  hyp- 
notic is  hydrotherapy* 

The  best  plan  to  be  used  in  the  treatment  of  insomnia  is  a  general 
treatment  that  has  for  its  object  the  toning  of  the  nervous  system, 
the  favoring  of  elimination  and  reconstruction  of  the  general  health, 
at  the  same  time  increasing  appetite,  digestion  and  assimilation.  This 
is  best  accomplished  by  the  conjoint  use  of  the  electric  light  bath 
until  perspiration  is  induced,  followed  by  the  horizontal  or  circular 
rain  bath  for  two  minutes  at  a  temperature  of  100°  F.,  rapidly  re- 
duced to  80°  F.  for  one-fourth  minute,  pressure  twenty-five  pounds. 
Decrease  temperature  two  degrees  to  65°  and  increase  pressure  one 
pound  daily  until  thirty  is  registered.  When  this  point  is  reached 
finish  the  treatment  by  applying  the  jet  douche  to  the  spine  at  65° 
for  ten  seconds,  up  and  down  the  posterior  aspect  of  the  limbs  for 
ten  seconds.  Where  there  is  much  digestive  disturbances  we  may 
also  include  a  mild  fan  douche  to  the  epigastrium  and  abdomen.  In 
applying  the  cold  jet  to  the  spine,  limbs  and  epigastrium  the  total  time 
should  not  be  over  fifteen  to  twenty  seconds,  and  the  column  of  water 
must  be  kept  rapidly  moving. 

Of  all  the  measures  that  are  used  to  produce  sleep  the  full  wet 
pack  is  by  far  the  best.  We  may  commence  the  pack  in  delicate 
patients  with  a  temperature  of  90°  F.  and  a  duration  of  thirty  min- 
utes, applying  same  at  bedtime.  The  temperature  of  the  pack  and 
the  duration  may  be  changed  rapidly  in  the  course  of  a  week,  say 
dropping  five  degrees  in  temperature  and  increasing  the  duration 
five  minutes  nightly  until  we  have  reached  a  temperature  of  60°  F. 
and  a  duration  of  one  hour.  Care  should  be  exercised  to  keep  the 
ice-cap  on  the  head  during  its  application.  It  is  very  important  to  note 
that  no  secondary  reaction  is  demanded  upon  the  removal  of  the 
patient  from  the  pack.  The  patient  should  be  dried,  the  night-dress 
gotten  on  as  quickly  as  possible,  quiet  enjoined,  a  glass  of  hot  milk 
given  and  sleep  sought.  Many  patients  sleep  during  the  application 
of  the  pack,  and  where  this  is  the  case  it  may  be  noted  that  its  max- 
imum good  is  being  accomplished.  It  must  be  borne  in  mind  that 
this  treatment  can  be  applied  in  any  house  in  the  land,  and  for  that 
reason  its  use  should  become  universal.  It  is  an  interesting  fact  that 
by  means  of  hydrotherapy  sleep  may  be  induced  by  infinitesimal  doses 
of  the  ordinary  hypnotics. 

The  next  best  measure  is  the  neutral  bath  at  a  temperature  of 
94°  F.  for  forty  minutes.  Commence  the  first  night  with  a  tempera- 
ture of  9^°  to  98°  F.  and  a  duration  of  fifteen  minutes,  dropping 
the  temperature  one  degree  nightly  and  increasing  the  duration  ten 
minutes  until  a  temperature  of  94°  F.  and  a  duration  of  forty  and 
even  sixty  minutes  is   reached.     Care  should  be  taken  that  the  hair 


396  PRACTICAL  HYDROTHERAPY. 

does  not  become  wet,  and  that  the  patient,  as  far  as  possible,  remains 
quietly  in  the  bath.  He  should  be  rapidly  dried,  avoiding  everything 
that  would  tend  to  cause  a  coryza,  retiring  to  bed  promptly,  taking 
hot  food,  and,  if  necessary,  a  small  dose  of  hypnotic,  though  this 
latter  is  usually  dropped  after  a  short  time. 

A  minor  measure  that  has  frequently  produced  sleep  in  mild  cases 
of  insomnia  is  an  alternate  hot  and  cold  sponge  to  the  spine.  This 
will  oftentimes  allay  the  cerebral  congestion  and  irritability,  and  thus 
place  the  patient  suffering  from  the  simpler  forms  of  insomnia  in 
an  excellent  position  to  sleep.  Chapman's  ice-bags  applied  from  the 
mid-dorsal  to  the  sacral  vertebras  and  kept  in  position  for  one  hour 
nightly  has  in  some  cases  relieved  the  condition  when  other  measures 
failed.  Continental  physicians  are  very  fond  of  the  use  of  the  brief 
cold  sitz  bath  at  a  temperature  of  70°  to  50°  F.  for  two  to  five 
minutes  just  before  retiring.  The  prolongation  of  the  bath  beyond 
five  minutes  will  have  the  reverse  effect  and  produce  wakefulness. 
It  is  therefore  better  to  err  on  the  side  of  brevity. 

The  trunk  compress  or  Neptune's  girdle  applied  at  a  temperature 
of  65°  F.  and  worn  all  night  will  relieve  some  cases,  especially  where 
we  have  to  deal  with  gastro-intestinal  diseases  or  where  there  is 
irritability  of  the  sympathetic  nerve  in  the  abdomen.  Insomnia 
brought  about  by  excessive,  irregular,  and  over-acting  heart  wTill 
oftentimes  be  benefited,  comfort  given,  and  psychic  relief  brought 
about  by  the  application  of  the  ice-bag  to  the  precordium.  Where 
insomnia  is  accompanied  by  coldness  of  the  lower  extremities  the 
foot-bath  at  a  temperature  of  40°  to  50°  F.  for  a  half  to  one  minute 
at  bedtime  may  be  found  of  possible  use.  A  local  wet  pack  may  be 
employed  in  these  cases  by  wetting  a  pair  of  stockings  in  water  at 
60°  to  50°  F.  and  covering  them  with  dry  ones.  They  should  be 
worn  all  night. 

Associated  measures  of  considerable  value  are  general  massage, 
static  electricity  and  cerebral  galvanization. 

A  most  excellent  plan  in  the  conduct  of  a  case  of  insomnia  is  to 
first  remove,  as  far  as  possible,  causal  factors ;  institute  the  proper 
hygiene,  diet  and  exercise;  general  tonic  hydrotherapy  for  recon- 
structive and  sedative  effects  during  the  morning  and  the  adminis- 
tration at  bedtime  of  one  of  the  hydriatic  hypnotics,  and,  should  it 
be  necessary,  in  conjunction  with  this  treatment  small  doses  of  one 
of  the  well-known  medicinal  remedies  of  this  nature.  Special  atten- 
tion should  be  paid  to  auto-intoxication,  digestive  disorders,  con- 
stipation and  nervous  irritability. 

Vertigo;  Tinnitus  Aurii;  Tinnitus  Cerebri. 

These  disorders  are  grouped  because  they  are  affections  that  have 
a  similarity  of  cause  and  treatment,  and  are  often  associated  together. 


FUNCTIONAL  NERVOUS  DISEASES.  3()7 

Vertigo  is  a  disturbance  of  the  sense  of  equilibrium  characterized 
by  apparent  movements  of  external  objects  <»r  the  person  himself. 
It  is  a  most  common  disorder,  usually  dependent  Upon  some  other 
condition  cr  disease — a  symptom,  though  at  times  it  appears  cause- 
less, possibly  a  pure  neurosis.  It  is  usually  due  to  souk-  irritation  of  the 
space-sense  portion  of  the  eighth  cranial  nerve — that  is  to  say,  the 
nerve  of  Cyon — the  lesion  or  disturbance  being  believed  to  be  in  and 
around  the  semicircular  canals.  Mendel  claims  it  is  due  to  functional 
disturbance  of  the  ganglion  cells  of  the  ocular  nuclei,  and  is  condi- 
tioned by  the  circulation.  The  disorder  is  frequently  accompanied 
by  nausea,  depression  and  sometimes  vomiting. 

Vertigo  is,  as  a  rule,  terrifying.  The  subjective  disturbances  of 
consciousness  make  patients  realize  their  apparent  helplessness;  it 
comes  on  suddenly,  and.  while  it  lasts  but  a  moment,  the  ideas  be- 
come confused,  the  patient  upset,  and  an  endeavor  made  to  grasp 
near  objects.  It  is  sometimes  so  severe  that  the  patient  falls.  It  is 
increased  by  sudden  movements  and  relieved  by  lying  down. 

Impulses  flow  into  the  central  nervous  system  from  the  semi- 
circular canals  and  ampullae  through  the  vermis  to  the  cerebellum ; 
others  from  the  eye  and  its  governing  muscles;  from  the  viscera, 
muscles  and  joints ;  they  constitute  our  communication  with  the  world 
and  external  objects  by  means  of  which  we  are  able  to  maintain 
equilibrium.  These  impulses  are,  as  a  rule,  uninterrupted  and  con- 
tinuous, and  anything  that  tends  to  break  or  disturb  this  flow  of 
impulses  or  interferes  with  the  precortical  appreciation  of  same  will 
produce  disturbances  of  equilibrium — that  is,  vertigo. 

The  piognosis  of  the  organic  variety  depends  upon  the  causal 
disease.  Meniere's  disease  may  be  helped  while  deafness  is  pro- 
gressing. The  prognosis  of  the  vertigo  of  neuroses  is  generally  good, 
while  that  of  ordinary  vertigo  is  excellent. 

The  treatment  resolves  itself  into  that  of  the  attack  and  the 
chronic  state.  During  the  attack  the  horizontal  position  should  be 
continually  sought,  the  clothing  loosened,  and  volatile  stimulants  ad- 
ministered;  if  indigestion  be  present,  the  stomach  washed;  if  the 
heart  is  weak,  the  ice-bag  applied  to  the  precordium.  As  soon  as  the 
attack  has  subsided  endeavor  should  be  made  to  find  its  cause  and 
the  condition  treated.  If  we  have  to  deal  with  a  vertigo  in  which 
the  heart  and  circulation  are  at  fault,  nothing  will  give  such  good 
results  as  the  institution  of  the  full  Schott  method  of  carbon  dioxide 
baths  and  graduated  exercises:  if  it  is  toxic,  tobacco,  alcohol,  coffee 
and  tea  should  be  forbidden.  The  diet  must  be  adapted  to  the  con- 
dition that  the  gastric  analysis  has  shown  to  be  present. 

The  general  measures  we  may  adopt  in  the  treatment  of  vertigo 
should  commence  with  the  full  dry  pack  until  the  skin  is  warm,  which 
usually  requires  twenty  to  thirty  minutes,  this  to  be  followed  by  the 


398  PRACTICAL  HYDROTHERAPY. 

cold  sponge  at  a  temperature  of  80°  F.,  reducing  two  degrees  daily 
to  60°  F. 

A  plan  suitable  for  the  home  or  for  those  whose  reaction  is  poor 
would  be  the  following:  Dry  pack  for  half  to  one  hour,  followed  by 
cold  sponge  with  water  at  a  temperature  of  70°  F.  After  a  few  days 
of  this  treatment  give  the  dry  full  pack  for  thirty  minutes,  followed 
by  the  dripping  sheet  at  70°  F.  for  three  minutes,  with  vigorous 
friction.  As  soon  as  this  point  is  reached  dispense  with  the  dry  pack 
and  give  the  dripping  sheet  at  65°  F.  for  three  minutes,  with  good 
friction,  while  the  patient  stands  in  a  foot-tub  of  water  as  hot  as  can 
be  borne.  Reaction  must  be  secured.  This  treatment  is  generally 
administered  in  the  morning,  and  when  this  time  is  selected  give  the 
general  wet  pack  at  65°  F.  for  one  hour  at  bedtime.  When  the 
patient  is  removed  from  the  pack  he  is  rapidly  dried  and  no  reaction 
is  sought.  The  advantage  of  this  method  of  treatment  is  to  obtain 
the  stimulating  and  tonic  influences  of  the  dripping  sheet  in  the 
morning  and  the  sedative  and  sleep-producing  effects  of  the  wet  pack 
at  bedtime. 

Another  good  method  is  to  have  the  patient  at  first  sit  in  a  half 
bath  with  water  at  102°  to  104°  F.,  while  the  attendant  gives  him 
an  affusion  at  80°  F.  to  the  spine,  back  and  chest.  Reduce  tempera- 
ture five  degrees  daily  to  65°  F.  At  this  point  the  patient  should 
stand  in  the  tub  in  water  as  hot  as  can  be  borne  while  the  affusion 
is  given  to  the  entire  body  or  the  water  is  thrown  with  force  against 
the  body  from  a  large  dipper.  This  may  be  further  modified  by 
first  immersing  the  body  in  the  warm  water,  then  giving  a  salt  rub 
or  glow,  followed  by  the  affusion.  The  warm  full  bath  at  104°  to 
105°  F.  for  five  or  seven  minutes,  followed  by  the  salt  rub  and 
finally  by  the  cold  shower  at  70°  to  65°  F.  will  be  found  useful. 
Reaction  is  essential. 

Reaction  will  by  this  time  be  active,  and  the  next  mentioned 
treatment  may  be  then  employed.  Many  cases  may  be  started  on 
this  treatment  who  have  ordinary  fair  reaction.  Electric  light  bath, 
hot-air  bath  or  superheated  dry  hot  air  body  apparatus  until  per- 
spiration takes  place.  Horizontal  or  circular  rain  bath  at  a  tem- 
perature of  100°  F.  for  one  and  one-half  minutes,  reduced  to  60°  F. 
for  ten  to  fifteen  seconds,  twenty-five  pounds'  pressure.  After  five 
or  six  treatments  of  this  character  have  been  administered  we  may 
give  the  following:  Electric  light  bath  to  the  point  of  free  perspira- 
tion, followed  by  the  circular  or  horizontal  rain  bath  at  103°  F.  for 
one  and  one-half  minutes,  rapidly  reduced  to  60°  F.,  pressure  twenty- 
five  pounds,  for  five  to  ten  seconds,  followed  by  the  fan  douche  to 
the  body  and  the  jet  douche  to  the  spine  at  60°  F.,  pressure  twenty 
to  thirty  pounds,  for  five  to  ten  seconds.  Where  this  treatment  is 
applied  the  attendant  will  have  to  move  quickly  so  that  the  patient  will 


FUNCTIONAL  NERVOUS  DISEASES.  399 

not  become  chilled  between  the  administration  of  the  rain  bath  and 
the  douche. 

\\  here  we  have  to  deal  with  much  gastro-intestinal  disturbance 
we  may  modify  the  treatment  with  the  following:  Electric  light  bath 
to  free  perspiration;  circular  or  horizontal  rain  bath  at  104°  F.  for 
one  and  one-half  minutes,  rapidly  reduced  to  60°  F.  for  ten  seconds, 
pressure  twenty-five  pounds,  followed  by  a  strong  fan  douche  to  the 
abdominal  walls  and  the  jet  douche  to  the  spine  for  a  period  not  to 
exceed  five  to  ten  seconds.  This  is  a  powerful  treatment,  and  care 
must  be  taken  in  its  application.  Some  cases  will  be  found  much 
benefited  by  the  use  of  the  trunk  compress  or  "Neptune's  girdle"  at 
a  temperature  of  65°  F.  for  one  hour.  Where  it  is  possible,  the  pa- 
tient should  take  the  general  treatment  heretofore  mentioned,  as  it 
is  more  successful. 

Sea-sickness. 

Naupathia,  or  mal  dc  mcr,  is  the  name  applied  to  a  definite  group 
of  symptoms  that  occur  usually  in  persons  on  board  a  vessel  at  sea, 
occasionally  when  the  subject  is  in  a  rapidly  moving  railway,  trolley, 
elevator,  swing  or  merry-go-round,  and  in  which  nausea  and  vom- 
iting are  the  most  marked  phenomena.  Young  children  are  very 
little  affected,  the  lower  animals  frequently  so.  The  symptoms  vary 
from  uncomfortableness  to  mental  and  physical  collapse,  and  are 
characterized  by  disgust  for  food,  nausea,  obstinate  vomiting,  by 
chilliness,  pallor  of  the  face  and  lips,  headache,  soreness  in  the  back, 
neuralgic  pains  in  the  extremities,  mental  depression,  despondency, 
and  a  general  lack  of  mental  capacity.  The  skin  is  pale,  cold,  clammy; 
the  urine  diminished,  the  pulse  small,  feeble  and  easily  compressed. 
Its  cause  is  supposed  to  be  a  disturbance  or  rupture  of  labyrinthine 
compensation  affecting  the  space-sense  of  the  eighth  nerve.  Mechan- 
ical concussion  of  the  nerve  elements,  auto-intoxication,  lowered  vas- 
cular tone  and  morbid  suggestion  certainly  influence  in  some  cases. 

Treatment. — Hydrotherapy  should  form  an  important  element  in 
the  prophylaxis  and  treatment  of  the  disease.  The  use  of  calomel  and 
salines,  together  with  enemas  of  normal  saline  solution,  for  a  week 
before  sailing  will  be  found  advantageous.  Those  contemplating  a 
trip  across  the  ocean  may  commence  with  a  cold  sponge  night  and 
morning  at  70°  F.,  reduce  three  degrees  each  application  to  50°  F. 
After  three  days'  use  of  this  method  we  may  employ  the  hot  full 
bath  at  104°  F.  for  five  minutes,  followed  by  the  salt  rub.  the  treat- 
ment being  terminated  by  the  use  of  the  shower  at  60°  F.  for  one- 
fourth  minute.  Both  of  these  treatments  should  be  followed  by  vigorous 
friction  with  a  crash  towel.  Those  who  have  access  to  institutional 
methods  should  immediately  be  placed  upon  the  electric  light  bath 
to   full   perspiration,    followed  by  the   rain  bath   at   102°    F.    for  one 


400  PRACTICAL  HYDROTHERAPY. 

minute,  reduced  to  70°  F.  for  one- fourth  minute.  Give  treatment 
daily  and  reduce  the  cold  water  five  degrees  each  treatment  to  60° 
to  55°  P.  At  the  end  of  the  three  days,  in  addition  to  the  foregoing, 
the  cold  jet  should  be  applied  up  and  down  the  spine  and  over  the 
posterior  aspects  of  the  lower  limbs  for  ten  to  fifteen  seconds.  It 
is  astonishing  how  quickly  the  vasomotor  system  and  space-sense  can 
be  affected  by  these  measures.  Upon  going  aboard  ship  the  very 
susceptible  should  discontinue  the  use  of  tonic  cold  hydrotherapy 
heretofore  suggested,  and  spend  as  much  time  as  possible  on  deck 
in  the  fresh  air,  reclining  in  a  steamer  chair.  From  some  personal 
observation,  and  from  its  use  in  cases  of  nausea  and  vomiting  from 
other  causes  as  well  as  sea-sickness,  the  writer  can  state  that  the  use 
of  the  Chapman  spinal  ice-bag  will  be  found  of  very  great  service  in 
the  management  of  these  cases,  increasing  as  it  does  the  vascular 
tone  by  stimulation  of  the  spinal  centers.  It  can  be  used  aboard  ship 
while  the  patient  reclines  upon  deck.  Another  excellent  method  is 
the  fomentation  applied  to  the  epigastrium  at  a  temperature  of  130° 
to  140°  F.  for  ten  minutes,  repeated  for  ten  minutes  and  followed  by 
the  ice-bag  over  the  epigastrium  for  thirty  to  sixty  minutes.  The 
abdominal  compress,  trunk  pack  or  Neptune's  girdle  will  be  found 
serviceable  in  certain  cases. 

Yeman*  says  that  he  has  employed  the  hot  full  dry  pack  to  the 
entire  body,  including  the  head,  and  found  it  of  great  value.  He  con- 
tinues its  use  until  the  superficial  blood-vessels  are  fully  dilated. 

Eugene  Wolf,  a  noted  German  traveler,  has  found  the  use  of  hot 
towels  to  the  head  efficacious. 

Occupation  Neurosis;  Professional  Neurosis;  Fatigue  Neurosis; 
Writers'  and  Other  "Cramps." 

Occupation  neurosis  or  functional  fatigue  neurosis  is  character- 
ized by  a  spasmodic,  tremulous,  paralytic  or  painful  disturbance,  com- 
ing on  when  the  movements  are  attempted,  the  parts  becoming  rapidly 
fatigued  when  their  use  is  continued. 

The  essential  causation  of  the  disorder  is  the  constant  repetition 
of  certain  muscular  movements  which,  by  strain  and  overuse  of  cer- 
tain groups,  give  rise  to  muscular  disturbances.  The  condition  is 
usually  manifested  by  spasm,  pain,  weakness  and  tremor  in  varying 
degree  and  combination.  This  is  true,  whether  the  affection  be  wri- 
ter's cramp,  seamstresses'  spasm,  telegraphers'  cramp,  or  any  other 
of  the  many  now  well-recognized  varieties.  The  more  highly  organ- 
ized the  function,  the  more  intricately  and  delicately  balanced  the 
movements,  the  more  readiiy  does  the  part  take  on  fatigue  and  inhibi- 
tion. There  have  been  no  pathological  findings  in  these  cases.  The 
most  common  forms  in  my  experience  have  been  writers'  and  telegra- 

4  Yeman,    H.    W. :    Tournal    American    Medical    Association,    December   21,    1907. 


FUNCTIONAL  NERVOUS  DISEASES.  401 

pliers'  cramp,  and  these,  or  one  of  them,  will  serve  as  a  type  for  the 
rest. 

Writers'  cramp  dates  from  1820,  when  steel  pens  were  introduced, 
and  was  much  more  common  during  the  earlier  years  of  their  use 
than  later,  when  the  "American  method"  of  writing  came  into  vogue. 
This  method  consists  of  the  use  of  the  forearm  muscles  as  a  fulcrum 
and  the  upper  arm  and  shoulder  muscles  as  the  moving  factor.  It 
is  essentially  the  free  and  open  style  of  writing.  These  disorders 
occur  more  frequently  in  men  than  women,  and  are  especially  prone 
to  attack  the  clerical  force.  It  is  usually  found  between  the  ages  of 
twenty  and  forty,  between  which  ages  clerks  are  most  likely  to  have 
a  great  deal  of  writing  to  do.  Rapidity  of  writing,  improper  handling 
of  the  pen  or  telegraph  key,  have  a  tendency  to  produce  the  disorder. 
The  predisposing  causes  are  intemperance  and  other  debilitating  dis- 
eases.    In  a  few  cases  injury  has  produced  the  disorder. 

The  onset,  as  a  rule,  is  slow  and  insidious,  commencing  with  a 
discomfort  and  stiffening  in  the  parts  affected.  After  a  short  while 
fatigue,  pain  and  soreness  take  place  upon  the  use  of  the  hand.  This 
condition  may  last  for  years,  but  gradually  grows  worse  with  time; 
the  parts  begin  to  ache,  feel  numb,  weak,  cramped  and  tremulous. 
Rest  and  rubbing  temporarily  ease  the  condition.  Gradually  less  and 
less  use  and  more  frequent  attacks,  which  may  by  this  time  have  grown 
so  violent  as  to  throw  the  objects  from  the  hand  or  fingers,  or  the 
muscles  may  slowly  open  the  hand  in  painful  spasm.  Hand-writing 
grows  from  bad  to  worse;  the  grip  on  the  key  is  quickly  released, 
although  sufferers  resort  to  many  and  various  devices  to  overcome 
their  debility.  New  pens  and  holders  are  used,  new  places  are  se- 
lected to  press  the  key,  but  finally  their  use  becomes  impossible  and 
the  hand  refuses  to  write  or  press  the  lever.  If  a  change  is  made 
to  the  other  hand,  in  a  short  while  it  becomes  involved. 

Cramps  are  the  most  common,  next  the  painful  form.  The  author 
has  never  seen  a  case  of  the  paralytic  variety,  although  German  authors 
speak  frequently  of  its  occurrence.  Patients  suffering  from  this  disor- 
der are  generally  nervously  run  down,  anemic — in  fact,  neurasthenoid. 

Of  the  pathology  of  the  disorder  little  is  known.  The  author  has 
always  felt  that  the  discoveries  of  Hodge  gave  a  clear  idea  of  what 
is  likely  the  condition  of  the  centers  affected.  It  will  be  recalled  that 
Hodge,  examining  the  neuron  bodies,  found  that  after  fatigue  cer- 
tain changes  took  place.  These  changes  were  ascribed  to  the  use  of 
the  part.  It  seems  likely  that  we  have  to  deal  here  with  the  same 
condition,  an  exhaustion  or  fatigue  followed  by  a  true  fatigue  neuro- 
sis. The  lesion  certainly  must  be  central,  and  involves  probably  the 
gray  matter  of  the  cerebral  cortex  and  the  afferent  and  efferent  paths. 
In  some  cases  a  myositis,  a  neuro-myositis,  or  at  times  a  true  neuritis 
is  present 


402  PRACTICAL  HYDROTHERAPY. 

The  dv:,order  is  a  chronic  one,  and  to  ordinary  treatment  incurable. 
The  painful  form  is  the  best  to  treat,  and  the  presence  of  a  peripheral 
origin  makes  for  a  better  chance  of  recovery.  The  best  method  of 
treatment  usually  cannot  be  followed  out,  owing  to  the  fact  that  clerks 
and  operators  cannot  afford  the  time  nor  the  expense  to  take  the  ra- 
tional and  needed  rest  and  treatment.  They  usually  "hang  on"  until 
they  are  compelled  to  give  up  their  positions  and  occupations.  The 
author  has  systematized  his  treatment  of  these  cases  into  the  use  of 
hydrotherapy  to  tone  up  the  general  health,  massage  to  overcome 
the  muscular  spasm,  and  static  electricity  for  its  general  tonic  and  local 
effects. 

A  plan  suitable  for  the  home  or  for  those  whose  reaction  is  poor, 
would  be  the  following:  Dry  pack  for  half  to  one  hour,  followed  by 
a  cold  sponge  with  water  at  a  temperature  of  70°  F.  After  a  few  days 
of  this  treatment  give  the  full  dry  pack  for  thirty  minutes,  followed  by 
the  dripping  sheet  at  70°  F.  for  three  minutes,  with  vigorous  friction. 
As  soon  as  this  point  is  reached,  dispense  with  the  dry  pack  and  give 
the  dripping  sheet  at  65°  F.  for  three  minutes,  with  good  friction, 
while  the  patient  stands  in  a  foot  tub  of  water  as  hot  as  can  be  borne. 
Reaction  must  be  secured.  This  treatment  is  generally  administered 
in  the  morning,  and  when  this  time  is  selected  give  the  general  wet 
pack  at  b5°  F.  for  one  hour  at  bedtime.  When  the  patient  is  removed 
from  the  pack  he  is  rapidly  dried  and  no  reaction  is  sought.  The  ad- 
vantage of  this  method  of  treatment  is  to  obtain  the  stimulating  and 
tonic  influences  of  the  dripping  sheet  in  the  morning  and  the  sedative 
and  sleep-producing  effects  of  the  wet  pack  at  bedtime. 

Another  good  method  is  to  have  the  patient  at  first  sit  in  a  half 
bath  with  water  at  102c  to  104°  F.,  while  the  attendant  gives  him 
an  affusion  at  80°  F.  to  the  spine,  back  and  chest.  Reduce  temper- 
ature five  degrees  daily  to  65 c  F.  At  this  point  the  patient  should 
stand  in  the  tub  in  water  as  hot  as  can  be  borne  while  the  affu- 
sion is  given  to  the  entire  body,  or  the  water  is  thrown  with  force 
against  the  body  from  a  large  dipper.  This  may  be  further  modified 
by  first  immersing  the  body  in  the  warm  water,  then  giving  a  salt 
rub  or  glow,  followed  by  the  affusion.  The  warm  full  bath  at  104° 
to  105c  F.  for  five  to  seven  minutes,  followed  by  the  salt  rub  and 
finally  by  the  cold  water  shower  at  70°  to  65°  F.,  will  be  found  useful. 
Reaction  is  essential. 

Hydrotherapy  may  be  applied  daily  in  these  cases,  in  the  shape 
of  the  electric  light  bath,  hot-air  or  vapor  bath  until  free  perspiration, 
followed  by  the  horizontal  or  circular  rain  bath  at  100°  F.,  reduced 
to  65°  F.,  pressure  twenty-five  pounds.  Massage  or  vibration  should 
be  applied  in  these  cases,  both  generally  and  locally.  The  static  treat- 
ment employed  is  that  of  heavy  sparks  to  the  spine  and  over  the  arm 
and  hand ;  the  hand  is  placed  in  the  position  in  which  it  is  most  used, 


FUNCTIONAL  NERVOUS  DISEASES.  403 

and  static  sparks  applied  to  muscular  groups  to  produce  contractions; 
after  this  the  wave  current  is  given  over  the  hand  and  arm  for  ten 
minutes.  Rest  from  use  and  occupation  can  materially  aid  these  cases 
in  getting  well.  Where  this  treatment  has  been  persistently  followed 
out  the  author  can  record  some  of  the  most  satisfactory  results  in 
his  professional  experience,  but  it  is  useless  to  commence  the  treat- 
ment when  it  cannot  be  persisted  in  for  a  number  of  months. 

Paralysis  Agitans;  Parkinson's  Disease;  Shaking  Palsy. 

Paralysis  agitans  is  a  chronic  progressive  disease,  without  definite 
pathologic?:  anatomy,  characterized  by  tremor,  muscular  rigidity  and 
weakness,  causing  a  peculiar  attitude,  gait,  vasomotor  phenomena  and 
restlessness.  The  disease  occurs  in  the  period  of  late  maturity,  from 
the  fiftieth  to  the  seventieth  year,  and  where  cases  occur  under  this 
age  limit  we  are  apt  to  find  symptoms  of  pre-semhty.  Males  are 
much  more  frequently  affected  than  females,  the  disease  occurring  in 
all  classes  and  stations  of  life.  Observers  have  noted  that  the  Irish 
are  more  Trequently  affected  with  this  disease,  Americans  next,  and 
then  follow  the  Jews  of  Poland  and  Russia.  Heredity  is  rare,  though 
at  tinies  we  find  indirect  heredity  which  does  not  account  for  the  dis- 
ease. It  is  not  found  in  those  who  are  the  subjects  of  syphilis,  alco- 
holism or  vice,  in  this  respect  differing  from  many  other  diseases. 
In  like  manner  no  occupation,  and  neither  an  active  nor  sedentary 
life,  predispose.  Worry,  anxiety,  and  prolonged  hard  labor  have  been 
said  to  be  the  predisposing  causes  of  the  affection.  Of  causes  that 
directly  excite  the  disease  may  be  mentioned  fright  and  injury.  These 
become  doubly  active  where  we  have  psychic  shock  superadded  to 
physical  trauma.  Its  development  is  insidious,  usually  being  preceded 
by  a  sense  of  weariness  for  a  variable  length  of  time,  after  which  it 
may  be  observed  that  a  fine  tremor  has  developed  in  one  extremity, 
for  the  disease  usually  starts  upon  one  side,  most  frequently  the 
light,  gradually  passing  to  and  affecting  the  other  side.  Later  ri- 
gidity and  the  peculiar  facies  develop  —  immobile,  expressionless, 
wooden.  The  body  becomes  bowed,  with  slight  flexion  of  the  ex- 
tremities, which  give  the  individual  an  appearance  of  being  aged. 
The  gait  is  shuffling,  the  speech  is  slow,  the  voice  piping.  "His 
big  manly  voice  changed  to  childish  treble."  The  vasomotor  phe- 
nomena in  the  shape  of  heat,  flushing,  burning,  redness  of  the  face, 
similar  to  that  of  the  drunkard,  make  their  appearance.  In  spite  of 
the  gravity  of  his  trouble,  the  patient  is,  as  a  rule,  non-emotional,  a 
striking  characteristic  of  the  disease — an  euthanasia,  as  it  were.  The 
course  of  the  disease  is  usually  progressive,  and  its  history  closed  by 
exhaustion  or  some  intercurrent  disease.  The  symptoms  are  increased 
by  physical  and  emotional  excitement.    Dana"'  says :  "The  post-mortem 

5    i  ana,  C.   L. :   "Text-Hook  of  Nervous  Diseases,"   1897. 


404  PRACTICAL  HYDROTHERAPY. 

changes  are  not  very  marked,  and  are  seen  mostly  in  the  spinal  c  va\ 
and  medulla — the  congestion  and  dilatation  of  the  vessels  in  the 
gray  matter,  and  diffuse  increase  of  interstitial  tissue,  atrophy  and 
pigmentation  of  cells.  The  process  is  suggestive  of  chronic  intersti- 
tial inflammation  with  cell  degeneration.  It  is  probably  a  post-infec- 
tious process,  with  toxins  behind  it.  The  cerebro-spinal  motor  neuron 
is  the  most  at  fault,  and  it  has  seemed  as  if  the  connection  between 
its  end-brush  and  the  motor  cells  of  the  spinal  cord  were  interfered 
with,  hence  the  peculiar  'hold-ups,'  the  rigidity  and  tremor  of  the  dis- 
ease. Paralysis  agitans  is  certainly  not  merely  a  premature  senility, 
as  some  have  taught." 

Treatment  resolves  itself  into  the  endeavor  to  stay  the  progress 
of  the  disease,  to  make  the  patient  comfortable  and  prolong  life. 
There  is  no  question  but  what  rest,  physical  and  mental  is  a  most 
valuable  agent  in  the  treatment  of  this  disease,  and  this  is  especially 
true  where  treatment  is  instituted  between  the  periods  of  rest.  Plenty 
of  fresh  air  is  beneficial,  no  climate  having  been  found  that  would 
seem  in  the  least  degree  to  influence  the  disease.  Diet  must  be  adapted 
to  the  case  in  hand,  but  should  be  plain,  simple,  nourishing,  care  being 
taken  to  have  the  food  well  cut  up  in  order  that  we  may  increase  the 
digestive  capacity  and  prevent  disorders  of  this  kind.  My  own  ob- 
servation has  been  that  treatment  along  this  line — that  is  to  say,  the 
correction  of  errors  of  digestion — has  done  much  to  make  the  patient 
comfortable  and  stay  the  progress  of  the  disease.  From  a  fair  though 
limited  experience  the  author  is  satisfied  that  medicines  are  of  little 
value,  neither  changing  the  course  of  the  disease  nor  curing  it,  some- 
times making  the  patient  more  comfortable.  The  most  serviceable 
ones  are  the  digestants,  laxatives,  codeine  and  extract  of  pituitary 
gland.  The  three  things  that  my  experience  has  taught  me  to  be  most 
helpful  in  paralysis  agitans  are  hydrotherapy,  massage  and  exercises. 
These  should  be  combined  into  a  system  of  treatment. 

Most  cases  suffering  from  paralysis  agitans  do  not,  as  a  rule,  react 
well  from  the  application  of  cold  water,  and  for  that  reason  they 
should  be  gradually  trained  to  stand  moderately  cold  temperatures. 
Where  the  case  is  very  much  run  down,  or  in  the  home,  we  may  com- 
mence the  treatment  with  the  full  dry  blanket  pack  for  twenty  to 
thirty  minutes,  followed  by  the  cold  sponge  at  a  temperature  of  85° 
F.,  repeated  daily,  lowering  the  temperature  one  or  two  degrees  each 
treatment  until  65°  F.  is  reached.  By  this  time  we  may  begin  the 
use  of  the  electric  light  bath  until  the  patient  just  begins  to  perspire, 
this  to  be  followed  by  the  horizontal  or  circular  rain  bath  at  100c  F. 
for  one  minute,  reduced  to  65°  F.  for  ten  seconds,  pressure  twenty 
pounds.  Reaction  must  be  secured.  The  writer  has  found  that  these 
cases  do  not  respond  well  to  the  hot  air,  superheated  dry  hot  air  or 
Turkish  bath.    They  should,  as  a  rule,  be  given  the  douche,  or  even  the 


FUNCTIONAL  NERVOUS  DISEASES.  405 

rain  bath  under  a  heavy  pressure,  it  will,  however,  be  found  that  where 
judicious  and  careful  applications  of  hydrotherapy  are  made  the  pa- 
tient's elimination  will  increase,  his  digestion  improve,  flesh  be  put  on 
and  the  vasomotor  phenomena  that  trouble  him  so  greatly  benefited. 
In  some  cases  the  tremor  and  rigidity  are  benefited  by  the  use  of 
the  neutral  bath  at  a  temperature  of  94°  F.  for  twenty  to  thirty  min- 
utes, followed  by  rest  for  one  hour  in  bed  or  upon  the  sofa. 

Massage  and  mechanical  vibration  are  of  unquestioned  value  in 
relieving  some  of  the  disagreeable  symptoms  and  increasing  the  gen- 
eral nutritional  effect.  They  should  be  general  in  character,  not  con- 
tinuing to  the  point  of  causing  fatigue,  especial  attention  being  given 
to  the  abdominal  contents,  with  a  view  of  increasing  digestion  and 
overcoming  the  constipation.  Exercises  will  be  found  of  great  value 
in  these  cases.  The  best  movements  are  those  of  passive  over-exten- 
sion, followed  by  extreme  contraction.  This  of  itself  will  overcome 
a  good  deal  of  the  tension  of  the  muscles.  These  movements  must 
perforce  be  given  by  the  physician  himself,  or  some  one  well  trained 
in  the  administration  of  therapeutic  exercises.  The  administration  of 
the  passive  exercise  should  be  followed  by  a  training  in  the  exercises 
of  precision,  or  what  is  commonly  known  as  Fraenkel's  method,  the 
details  of  which  have  been  mentioned  in  another  section.  These  ex- 
ercises should  be  gradually  increased  until  the  patient  takes  the  full 
and  complete  set. 

Sanatoria  offer  special  advantages  to  these  cases,  and,  in  fact,  many 
of  them  would  prolong  their  life  in  comfort  and  pleasure  could  they 
live  within  the  walls  of  some  well-regulated  institution.  Under  the 
constant,  careful  and  custodial  care  of  the  physician  and  nurse,  to- 
gether with  the  regular  mode  of  life  of  such  institutions,  with  the 
freedom  from  care,  strife  and  excitement,  we  are  able  to  alleviate 
their  sufferings,  make  them  more  comfortable,  and,  as  before  men- 
tioned, increase  their  span  of  existence  materially.  Those  who  have 
observed  carefully  their  hospital  experiences  have  learned  to  know 
that  though  probably  general  hospitals  offer  but  poor  facilities  in  the 
way  of  diet,  treatment  care  and  attention  for  these  cases,  still  striking 
improvement  is  often  noted  after  a  reasonable  sojourn  within  their 
wards. 

The  keynote  of  success  is  to  maintain  the  general  nutrition,  over- 
come the  various  symptoms  and  increase  tone. 

Facial  Spasm;  Mimic  Tic;  Spasmodic  Torticollis;  Wryneck; 
Spasmodic  Tics;  Habit  Spasm. 

Facial  spasm,  mimic  tic  or  habit  spasm  is  a  disease  characterized 
by  an  involuntary,  intermittent,  quick  twitching  of  the  facial  muscles, 
unaccompanied  by  pain  or  paralysis.  This  may  occur  as  a  closure  of 
the    eyelids    (blepharospasm),    movements   of   the    mouth   and   nose, 


406  PRACTICAL  HYDROTHERAPY. 

sucking  or  smacking  movements  of  the  lips,  sometimes  as  a  movement 
of  the  lateral  face  muscles,  and  often  accompanied  hy  head  and  neck 
movements  from  subsequent  involvement.  The  spasm  subsides  during 
sleep  and  is  lessened  by  repose.  It  may  last  for  years.  The  movements 
are  ordinarily  quick  and  lightning-like,  usually  quickly  repeated  from 
several  to  many  times.  Later  on  in  the  disease  the  spasm  may  become 
at  times  tcnic.  The  majority  of  my  cases  have  occurred  in  youth 
and  early  adult  life.  Some  authors  state  that  women  are  more  fre- 
quently affected  than  men,  though  my  personal  experience  has  been 
that  they  were  equally  divided.  Emotion,  fright,  worry  or  injury 
may  cause  an  attack,  and  these  conditions  always  increase  and  aggra- 
vate the  existing  spasm ;  likewise  excitement,  embarrassment  and  emo- 
tion. Some  authors  state  that  it  is  often  reflex,  from  irritation  of 
the  different  branches  of  the  trigeminal  nerve,  though  I  have  never 
seen  a  case  so  caused.  Generally  a  neuropathic  constitution  underlies 
the  disease,  the  pathology  of  which  is  unknown,  believed  by  some  to 
be  a  psycho-neurosis  and  by  others  a  degenerative  condition.  Xo 
known  anatomical  changes  have  been  discovered.  Life  is  never  en- 
dangered by  the  disease;  a  guarded  prognosis  should  always  be 
given. 

The  author  has  had  what  he  considers  to  be  most  excellent  results 
in  the  treatment  of  facial  spasm,  having  cured  seven  out  of  eight  cases. 
To  succeed  we  must  have  sufficient  time,  ten  to  twelve  months,  in 
order  to  bring  about  the  general  and  local  change  that  means  a  cessa- 
tion of  the  jerkings.  The  plan  adopted  has  been  as  follows :  The  pa- 
tient is  placed  upon  a  partial  rest  schedule  and  given  the  following 
treatment:  Being  up  and  about  we  may  commence  with  the  electric 
light  bath  or  superheated  dry  hot-air  bath  until  mild  perspiration  takes 
place,  at  the  end  of  two  or  three  treatments  increasing  their  duration 
until  profuse  perspiration  takes  place.  The  patient  is  removed  to  the 
horizontal  or  circular  rain  bath  at  temperature  of  102°  F.  for  one 
minute,  reduced  to  80°  F.  for  one- fourth  minute,  pressure  twenty 
pounds.  Reaction  is  secured,  and  after  this  he  is  wrapped  in  a  sheet 
and  reclines  upon  a  lounge.  The  bath  attendant  now  applies  the 
fomentation  wrung  unusually  dry  to  the  affected  muscles,  and  if  the 
spasm  has  extended  to  adjacent  groups  it  is  applied  over  these.  Two 
fomentations  are  applied,  and  as  a  finishing  treatment  the  area  is 
rapidly  sponged  with  water  at  a  temperature  of  60°  F.  As  soon  as 
the  patient's  reaction  is  well  established  we  should  rapidly  drop  the 
temperatuie  of  the  cold  water  until  60°  or  even  50°  F.  is  adminis- 
tered for  ten  or  fifteen  seconds.  When  this  point  has  been  reached 
add  to  the  above  treatment  the  jet  douche  to  the  spine  at  60°  F.  for 
five  to  ten  seconds,  thirty  pounds'  pressure,  taking  special  care  to  have 
the  patient  hold  the  head  back  and  giving  all  the  percussory  force 
possible  over  the  cervical  spine  and  occiput.     These  cases  must  reach 


FUNCTIONAL  NERVOUS  DISEASES.  407 

the  must  powerful  treatment  possible  before  good  results  can  be 
expected. 

This  is  given  in  the  morning  daily,  and  in  the  afternoon  or  evening 
a  galvanic  current  is  applied  to  the  muscles  affected  as  follows:  A 
compress  is  wrung  out  of  hot  water  containing  bicarbonate  of  soda 
and  applied  over  the  affected  muscles.  Over  this  a  large  electrode 
attached  to  the  positive  pole  of  the  galvanic  current  is  placed,  the 
negative  pole  of  which  is  applied  to  the  nape  of  the  neck.  Five  to 
twenty  milliamperes  for  three  to  seven  minutes  is  then  administered. 

If  complicating  troubles — reflex  irritations,  diseases  of  the  genito- 
urinary system  or  pelvic  disease — are  present  they  should  be  corrected, 
a  proper  dietary  instituted  and  the  treatment  persisted  in.  Internally 
the  author  uses  fluid  extract  of  gelsemium  or  atropine  hypodermically. 
In  this  manner  he  has  been  able  to  cure  permanently  some  of  the  most 
stubborn  cases  of  the  disease.  Permanently  is  stated  advisedly,  as 
some  of  his  cases  have  gone  fourteen,  thirteen,  eleven,  and  eight  years 
without  relapses. 

Spasmodic  torticollis  or  wryneck  is  an  irritative  lesion  of  the  spinal 
accessory  nerve,  characterized  by  tonic  or  clonic  spasms  of  the  muscles 
supplied  by  this  nerve.  The  disease  is  prone  to  spread  and  involve 
the  muscles  supplied  by  other  nerves,  especially  the  cervical.  As  a 
result  of  the  action  of  these  muscles  the  face  is  carried  forward,  turned 
to  the  opposite  side,  tilted  upward,  and  at  the  same  time  drawn  back- 
ward. The  sterno-cleido-mastoid  and  trapezius  muscles  are  usually 
the  ones  mainly  involved,  the  others  being  affected  later  in  the  disease. 
We  are  not  considering  congenital  wryneck  nor  that  which  arises  from 
spinal  bone  disease,  but  the  true  spasmodic  torticollis  and  the  so- 
called  "rheumatic"  wryneck.  The  spasms  are  usually  clonic  or  inter- 
mittent at  first,  and  gradually  become  more  constant,  more  permanent, 
until  they  may  become  tonically  rigid.  Spasmodic  torticollis  is  a  pure 
nervous  disease,  occurring  much  more  frequently  in  women  than 
men,  and  in  early  adult  and  middle  life.  Occupations  that  place 
the  neck  muscles  upon  a  strain,  blows  and  reflex  irritations  are  said 
to  cause  the  disease,  but  the  author  has  never  been  able  to  trace  their 
relationship,  and  especially  has  he  been  unable  to  find  any  of  the  so- 
called  "reflex"  conditions  causing  the  disease.  The  pathology  is  that 
of  a  bulbar  neurosis,  as  a  result  of  which  the  neuro-mechanism  gov- 
erning the  movement  of  the  neck  muscles  becomes  unstable,  indicating, 
according  tc  the  majority  of  authors,  a  premature  decay  of  the  nerve 
nuclei  of  the  nerves  involved,  with  a  secondary  involvement  of  the 
cortical  centers.  The  disease  is  not  fatal,  and  under  usual  treatment 
reaches  a  certain  stage  and  remains  chronic.  Certain  cases  of  the 
disease  are  relieved  and  cured,  others  are  ameliorated,  and  in  still 
others  no  benefit  is  received. 

From  a  moderate  experience  the  author  knows  no  way  by  which 


408  PRACTICAL  HYDROTHERAPY. 

curable  can  be  distinguished  from  incurable  cases,  save  that  of  per- 
sistent careful  trial.  Surgery  has  very  few  cures  to  its  credit,  very 
many  failuies,  and  has  oftentimes  caused  a  recurrence  in  a  new  near 
area.  The  method  which  the  author  has  finally  reached,  and  which 
has  given  him  the  greatest  success  in  the  treatment  of  this  disease, 
is  the  general  treatment  outlined  just  above  in  the  treatment  of  facial 
spasm — that  is  to  say,  the  electric  light  bath  or  superheated  dry  hot 
air  to  profuse  perspiration,  followed  by  the  horizontal  or  circular  rain 
bath  and  jet  douche  rapidly  pushed  to  extreme  toleration,  followed 
by  the  fomentation  and  sponge.  The  local  treatment  by  electricity  is 
a  little  different  from  that  administered  in  facial  spasm.  The  positive 
pole  of  the  high  tension  faradic  coil  and  the  negative  pole  of  the 
galvanic  current  are  carried  to  a  large  indifferent  electrode  placed 
upon  the  abdomen  or  lumbar  spine.  Two  hot  soda  compresses  are 
prepared  and  placed  on  either  side  of  the  neck;  to  the  spasmodic  side 
the  positive  pole  of  the  galvanic  is  applied  and  the  current  turned  on 
until  ten  to  twenty  milliamperes  passes ;  on  the  other  side — that  is  to 
say,  the  side  opposite  the  spasm — sufficient  of  the  faradic  current  from 
the  negative  pole  is  turned  on  to  produce  strong  enough  contraction 
to  rotate  the  head  into  and  slightly  beyond  the  normal  position.  The 
treatment  should  last  for  five  or  six  minutes.  As  a  result  of  clinical 
experience  the  author  is  prone  to  believe  that  those  cases  that  get  well 
are  of  the  pure  neurosis  type,  those  that  do  not  are  probably  degen- 
erative. Between  these  treatments  massage  is  administered  and  the 
patient  kept  at  rest  in  the  prone  position,  and  where  necessary  an 
apparatus  should  be  constructed  that  will  hold  the  head  in  its  natural 
position  and  stretch  the  tonic  muscles.  As  soon  as  we  notice  improve- 
ment in  the  condition  we  may  gradually  commence  such  resistive 
exercises  as  will  overcome  the  spasm.  This  had  best  be  supervised 
by  the  physician  himself. 

Rheumatic  torticollis  is  usually  found  in  children  and  very  young 
people,  the  author  having  seen  quite  a  number  of  these  cases.  Cold, 
exposure  and  rheumatism  are  causes  that  produce  the  disease.  In 
those  who  have  a  so-called  "rheumatic  tendency,"  exposure  to  cold 
in  the  way  of  a  draft  of  damp  moist  air  playing  upon  the  exposed 
muscles  of  the  neck,  is  very  liable  to  produce  the  disease.  A  myositis 
is  generally  present;  in  some  instances  the  author  is  satisfied  that  there 
was  a  neuritis.  These  cases  all  get  well,  and  the  most  favorable 
prognosis  may  be  given  provided  the  diagnosis  is  certain.  The  treat- 
ment is  both  general  and  local.  The  general  principles  outlined  in 
the  treatment  of  muscular  rheumatism  may  be  followed  in  this  affec- 
tion, but  the  author  has  found  the  superheated  dry  hot  air,  using  the 
body  apparatus,  is  singularly  effective.  No  difficulty  is  experienced 
in  getting  children  to  take  the  treatment.  The  patient  should  remain 
in  the  apparatus  for  twenty  minutes,  gradually  increased  to  forty,  and 


FUNCTIONAL  NERVOUS  DISEASES.  409 

the  temperature  given  ranging  from  200°  to  275°  F.,  great  care  being 
taken  to  carefully  cover  the  skin  with  Turkish  toweling.  Jn  the  case 
of  children  it  is  wise  to  have  a  large  sheet  of  Turkish  toweling  and 
wrap  them  in  it,  in  addition  to  the  usual  covering,  as  they  do  not,  as 
a  rule,  appreciate  the  necessity  of  remaining  quiet.  When  this  treat- 
ment is  finished  the  horizontal  or  circular  rain  bath  should  be  given 
at  a  temperature  of  102°  F.  for  one  minute,  reduced  to  80°  F.  for  ten 
seconds,  under  pressure  of  twenty-five  pounds.  In  older  children  and 
in  adults  we  may  have  recourse  to  the  Scottish  or  alternating  douche 
to  the  spine  at  a  temperature  of  105°  to  110°  F.  for  one- fourth 
minute,  followed  by  a  temperature  of  75°  F.  for  ten  seconds,  three 
to   four  alternations  being  necessary. 

In  the  local  treatment  of  these  cases  the  hot  compress  wrung  out 
of  hot  sods  water  and  applied  over  the  affected  muscles  in  connection 
with  the  positive  pole  of  the  galvanic  current  will  do  much  toward 
giving  relief.  Anti-rheumatic  medicines  may  be  administered  in- 
ternally at  the  same  time. 

Spasmodic  tics,  the  "tic  convulsif"  of  the  French,  is  a  chronic 
disease  characterized  by  quick,  sudden  spasms  of  a  single  muscle 
or  group  cf  muscles,  the  movements  being  complete,  strong  and 
occurring  as  a  movement,  more  frequently  as  a  series  of  movements 
repeated  several  times.  The  intervening  period  of  rest  is  variable. 
The  most  common  tics  are  those  of  the  orbicularis,  causing  blepharo- 
spasm and  facial  tic.  The  movements  are  sometimes  accompanied  by 
explosive  disturbances  of  speech.  "In  these  cases  the  patient  at  the 
time  of  the  convulsive  movement  utters  some  obscene  or  profane 
words  (coprolalia),  or  involutarily  repeats  the  last  word  of  the  sen- 
tence spoken  to  him  (echolalia),  or  spasmodically  imitates  a  gesture 
made  to  him  (cchokiiicsis),  or  involuntarily  exclaims  the  thought 
uppermost  in  his  mind,  probably  revealing  some  secret  against  his 
will  (tic  dr  pensee).  The  peculiar  disorder  of  the  Maine  "jumpers," 
characterized  by  sudden  violent  movements  upon  being  touched  or 
startled,  is  a  form  of  tic.  So  also  are  the  singular  troubles  known  as 
latah  occurring  in  Malay,  and  myriachit  occurring  in  Siberia  and 
Kamchatka"  (Dana).  The  treatment  of  these  disorders  is  unsat- 
isfactory. The  best  results  are  obtained  from  the  complete  rest 
treatment,  which  has  been  fully  dwelt  upon  heretofore ;  in  fact,  these 
cases  should  be  manage!  as  one  would  hysteria  of  severe  type.  The 
sine  qua  non  of  treatment  is  the  reconstruction  of  the  general  health, 
and  this  L  favorably  aided  by  hydrotherapy.  Gelsemium  sometimes 
helps. 

6  Dana,  C.  L.:  "Text-Book  of  Nervous  Diseases,"  1897. 


410  PRACTICAL  HYDROTHERAPY. 

Insolation,     Sun-Stroke;     Heat  Stroke;     Thermic  Fever;     Cerebral 

Hyperemia. 

Insolation  is  a  term  applied  to  a  series  of  symptoms,  accompanied 
by  a  depression  of  the  vital  forces,  occurring  as  a  result  of  exposure 
to  undue  or  excessive  heat.  It  is  too  great  accumulation  of  heat  within 
the  body  which  is  precipitated  upon  the  nervous  system — that  is  to  say, 
upon  the  brain  as  a  whole — probably  accompanied  by  intoxicating  pro- 
ducts of  tissue  metabolism. 

Males  are  more  frequently  affected  than  females,  owing  to  the 
fact  they  are  more  exposed  to  heat,  which  is  usually  the  principal 
factor  in  the  causation  of  the  trouble.  It  should  be  borne  in  mind, 
however,  that  in  an  exposure  to  sunlight  we  must  take  into  consider- 
ation the  actinic  ray.  for  in  sun-stroke  it  is  largely  the  actinic  ray 
rather  than  the  heat  that  causes  the  affection.  It  has  been  found  by 
the  British  army  authorities  that  the  pernicious  influence  of  the  actinic 
ray  may  be  overcome  by  lining  the  helmets  and  coats  with  yellow  silk, 
which  prevents  the  penetration  of  this  part  of  the  solar  spectrum.  In 
like  manner  the  Arabs  and  other  nomads  of  the  desert  have  for 
generations  bound  about  their  heads  the  gaudy  yellow  turban  in 
numerous  folds,  gratifying  alike  their  love  of  color  and  at  the  same 
time  shielding  themselves  from  the  effects  of  the  sun's  rays. 

Heat-exhaustion  may  be  brought  about  by  undue  or  excessive 
exertion  in  heated  temperatures,  especially  with  improper  ventilation. 
Exercise  strongly  favors  the  production  of  heat  stroke.  It  has  always 
seemed  to  the  author  a  matter  of  serious  import  to  see  small  children 
go  about  ai  the  seashore  with  their  heads  exposed  to  the  blazing  rays 
of  the  sun  while  they  wade  in  cold  water,  chilling  the  extremities  and 
favoring  a  condition  likely  to  be  followed  by  heat  or  sun-stroke. 

One  of  the  most  common  predisposing  causes  of  insolation  is 
indulgence  in  alcohol,  and  it  may  be  said  that  this  is  the  most  common 
and  the  most  dangerous  of  all  causes.  Alcoholics  are  careless,  ex- 
posing themselves  unduly,  and  owing  to  alcohol's  obtunding  action 
upon  brain  and  body  they  fail  to  appreciate  the  effect  of  the  heat 
upon  themselves.  Other  contributing  causes  are  great  bodily  fatigue, 
especially  in  unventilated  surroundings ;  much  mental  worry,  insuffi- 
cient food  and  unsanitary  surroundings.  Unusual  disturbances  of 
metabolism  accompany  these  cases.  It  is  a  well-known  fact  that  the 
presence  of  a  large  amount  of  moisture  in  the  air  is  favorable  to  the 
production  of  heat  stroke.  The  writer  has  experienced  intense  heat 
upon  the  plains  of  Colorado  and  Xew  Mexico  with  comparatively 
no  discomfort,  owing  to  the  dry  and  clear  atmosphere  of  these  regions. 
Insolation  is  much  more  apt  to  occur  in  the  "horny-handed  son  of 
toil,"  earn  ing  his  hod  or  wielding  his  sledge,  laying  a  tin  roof  or 
harvesting  the  hay,  running  a  steam  engine  or  firing  a  furnace,  than 


FUNCTIONAL  NERVOUS  DISH.  IS  IIS.  411 

the  citizen  who  sits  in  his  office  or  takes  his  exercise  under  a  raised 
umbrella,  accompanied  by  a  palm-leaf  fan. 

The  seizure,  as  a  rule,  is  accompanied  by  premonitory  symptoms 
of  a  sense  of  fullness  in  the  head,  headache,  vertigo,  distress,  fullness 
in  the  epigastrium,  and  a  general  sense  of  lassitude,  weakness,  dimness 
of  vision,  nausea,  and  later  insensibility.  It  should  be  borne  in  mind 
that  heat  stroke  is  but  a  mild  form  of  thermic  fever. 

The  development  of  the  attack  is  rapid  and  the  prostration  great. 
The  face  is  pale,  the  voice  weak,  the  pulse  rapid  and  feeble,  the 
respiration  quick,  temperature  102°  to  103°  F.  with  partial  uncon- 
sciouness.  Where  sun-stroke,  thermic  fever  or  true  hyperpyrexia 
takes  place,  which  is  an  aggravated  form  of  the  above,  we  find  that 
it  develop"',  more  suddenly,  with  insensibility  and  unconsciousness, 
with  or  without  delirium  or  moaning.  The  skin  is  flushed  and  red ; 
the  body  surface  hot,  dry  and  burning;  breathing  rapid,  shallow  and 
stertorous ;  pulse  quick,  full,  bounding  at  first,  rapid,  weak ;  tem- 
perature 104°  to  116°  F. 

The  pathology  is  unknown,  the  action  being  so  rapid  that  few 
structural  lesions  take  place,  although  all  the  organs  are  in  a  state  of 
venous  congestion.  The  blood  is  dark,  thin,  and  its  coagulability 
destroyed.  Post-mortem  rigidity  is  early  marked.  Lambert  and  Van 
Giesen,  after  investigating  805  cases,  came  to  the  conclusion  that  "the 
prodromal  symptoms  of  sun-stroke  are  those  of  acute  functional  dis- 
turbances, while  the  later  symptoms,  much  more  serious,  point  to 
grave  changes  in  the  blood  and  in  all  the  nerve  centers,  especially 
those  of  the  latter  which  control  the  thermic  mechanism  of  the  body." 
Universal  acute  degeneration  of  the  neurons  of  the  central  cortex  of 
cerebrum  and  cerebellum  takes  place,  the  same  changes  being  found  in 
less  intensity  in  the  spinal  cord.  The  changes  were  similar  to  those 
produced  by  alcohol,  lead  and  bacterial  products.  Organisms  have 
been  found  of  linear,  incurved  and  constricted  appearance,  with  Ali- 
ments, motile  but  no  cilia ;  their  relation  has  not  been  determined. 

It  has  always  seemed  to  the  author  that  insolation  was  the  resultant 
of  increased  production  and  diminished  elimination  of  heat,  together 
with  interference  with  the  mechanism  regulating  heat  production  and 
elimination.  Wood  says  that  "when  a  man  is  exposed  to  heat  beyond 
his  powrer  to  resist  there  is  a  gradual  and  slow  rise  of  temperature 
until  the  stimulus  of  heat  becomes  so  intense  as  to  paralyze  the  heat 
centers  and  vasomotor  nerves,  as  the  case  may  be,  with  probably  a 
sudden  intensifying  of  the  process  of  oxidation,  accompanied  by  the 
overwhelming  of  the  cerebrum." 

The  first  step  in  the  treatment  of  heat  exhaustion  or  sun-stroke 
is  an  immediate  removal  of  the  victim  from  his  surroundings  to  an 
atmosphere  as  cool  as  possible.  He  should  be  laid  upon  his  back,  his 
head  elevated,  and  all  clothing  immediately  loosened,  especially  any 


412  PRACTICAL  HYDROTHERAPY. 

constriction  about  the  neck  or  abdomen.  Cold  applications  must  be 
immediately  made  to  the  neck  and  head  by  means  of  wet  cold  cloths 
or  compresses.  Nothing  is  better  for  immediate  use  than  a  towel 
folded  lengthwise,  dipped  in  cold  water,  and  wrapped  loosely  about 
the  neck  while  cold  water  is  applied  to  the  head.  It  is  much  more 
efficacious  to  apply  the  cold  immediately  on  the  ground  than  to  wait 
until  the  patient  can  be  removed  to  some  hospital.  Much  valuable 
time  is  thereby  lost  and  the  patient'-  nerve  centers  endangered  by  the 
delay.  As  soon  as  possible  the  patient  should  be  removed  by  means 
of  an  ambulance  to  his  home,  or,  what  is  better,  some  hospital,  appli- 
cations of  cold  water  being  constantly  kept  up  during  the  trip. 
Ambulances  that  attend  such  calls  in  the  summer  should  be  supplied 
with  ice  and  cold  water,  the  former  of  which  must  be  kept  around  the 
patient's  head  while  cold  water  and  friction  are  applied  to  the  body 
surface  during  the  trip. 

Where  the  attack  is  sudden,  the  fever  high,  and  circumstances 
do  not  permit  the  removal  of  the  patient's  clothing,  no  attention  should 
be  paid  to  his  personal  apparel,  but  buckets  of  cold  water  should  be 
poured  or  dashed  over  him  from  a  distance  of  four  to  five  feet,  while 
several  persons  rub  his  arms,  legs  and  trunk.  The  writer  has  seen  a 
number  ot  these  cases,  and  not  in  any  except  in  case^  under  his  own 
control  has  he  ever  observed  the  application  of  friction  to  the  surface 
of  the  body  while  applying  cold  water.  The  rationale  of  this  proce- 
dure has  been  so  often  demonstrated  in  the  application  of  the  cold 
bath  in  typhoid  fever  and  all  conditions  of  pyrexia  that  it  should 
have  taught  the  profession  the  need  of  its  use.  There  is  present  a 
depreciation  of  the  vital  forces  of  the  nervous  system,  and  the  great- 
est benefit  that  is  derived  from  the  use  of  the  bath  is  as  a  nerve  stim- 
ulant, that  of  an  antipyretic  being  secondary.  The  application  of 
cold  accompanied  by  friction  dilates  the  blood-vessels  of  the  skin, 
draws  the  blood  from  the  brain  and  viscera,  favors  heat  elimination, 
causes  tonic  contraction  of  the  blood-vessels,  powerfully  stimulates 
the  vasomotor  system,  and  by  reflex  effects  lessens  heat  production. 
That  the  enormous  vascular  area  of  the  skin  is  capable  of  rapidly 
carrying  off  the  accumulated  heat  is  well  known,  and  the  reduction 
of  temperature  by  cold  applications  depends  largely  upon  the  excita- 
tion of  the  cold  and  friction  upon  the  peripheral  nerves  and  blood- 
vessels, rather  than  upon  its  direct  antithermic  or  heat-reducing  power. 
The  mechanical  effects  in  the  production  of  these  results  are  imme- 
diate, and  for  this  reason  it  has  been  suggested  that  the  water  should 
be  thrown  or  dashed  upon  the  patient  in  order  that  we  might  get  the 
stimulation  of  the  force  of  impact. 

When  the  patient  reaches  the  hospital  or  home  the  clothing  should 
be  immediately  removed  and  cold  applications  continued.  If  we  have 
to  deal  with  heat  prostration  where  the  pulse  is  feeble  and  weak,  the 


FUNCTIONAL  NERVOUS  DISEASES.  413 

temperature  nol  over  102°  or  103°  I\,  we  may  use  the  ablution. 
suggested  by  Baruch:7  "The  patient,  lying  upon  a  rubber  sheet  which 
is  covered  with  a  blanket,  is  rapidly  bathed  and  rubbed  for  ten  min- 
utes with  a  wash  cloth  or  large  crumpled  piece  of  surgical  gauze  sat- 
urated with  water  at  7?  V.  If  the  skin  shows  reaction,  this  ablution 
may  be  repeated  in  half  an  hour  with  water  at  70°  F.,  again  in  half  an 
hour  with  water  at  65°  F.,  and  so  on  until  the  rectal  temperature  falls 
two  to  three  degrees.  It  is  a  serious  error  to  continue  bathing  until  the 
temperature  approximately  reaches  the  normal  point."  Where  we 
have  to  deal  with  serious  pyrexia,  with  unconsciouMie— .  the  cold  pack 
may  be  applied.  Xo  blanket  should  be  used  in  this  application,  but 
a  sheet  kept  cold  by  repeated  wetting,  accompanied  by  friction.  This 
may  be  kept  up  for  thirty  or  forty  minutes,  while  during  its  applica- 
tion a  turban  wet  in  ice-water  or  an  ice-cap  is  applied  to  the  head. 
Unconsciousness  may  be  frequently  relieved  by  the  application  of  a 
fine  stream  of  ice-water  to  the  forehead  for  half  a  minute,  intermit- 
ting and  applying  several  times.  It  will  sometimes  arouse  patients 
when  all  else  fails.  When  the  temperature  subsides  to  102°  or  104° 
F.  the  patient  should  be  removed  to  a  dark  room,  preferably  kept 
cool  by  an  electric  fan,  and  cold  compresses  or  the  ice-cap  applied 
to  the  head  and  kept  there  during  the  stay  in  the  hospital.  The  pa- 
tient should  be  urged  to  drink  freely  of  ice- water  unless  high  arterial 
pressure  be  present.  All  the  emunctories  must  be  thoroughly  stim- 
ulated, and  upon  the  slightest  indication  of  a  secondary  rise  in  tem- 
perature, hydriatic  measures  should  be  at  once  adopted,  either  the 
Brand  full  bath  at  65°  F.  or  the  cold  pack  repeated.  The  patient  must 
be  kept  in  a  recumbent  position  for  several  days  under  the  cold-air 
blast.  As  a  rule,  exertion  and  too  long  continued  application  of  cold 
water  is  to  be  avoided.  Experience,  judgment  and  care  are  required 
to  adapt  hydrotherapy  to  these  cases,  but  success  is  usually  the  result 
of  its  intelligent  application.  The  author  has  found  in  cases  of  threat- 
ened cardiac  failure  the  ice-bag  applied  over  the  precordial  regi  n 
a  treatment  of  great  value. 

Foulds8  -ays  that  ice-water  enemata  are  very  valuable  in  the  treat- 
ment of  insolation.  In  his  Indian  experience  he  saw  many  case- 
the  affection,  with  a  greater  percentage  of  recovery  from  its  use,  al- 
though it  can  be  combined  with  external  methods.  A  quart  of  "'iced 
water"  was  given  per  rectum  until  the  axillary  temperature  fell  to 
102°  F.  All  cases  recovered.  Prodromal  symptoms  (drowsiness, 
headache,  dizziness,  temperature  103°  to  104°  F.)  were  so  treated  and 
patients  left  the  hospital  quite  well  on  the  following  morning. 

The  after-treatment  is  important,  and  should  consist  of  daily  gi 
uated  cold  applications,  care  being  taken  to  thoroughly  cool  the  head 

7  Baruch,   Simon:   "Hydrotherapy,"   1897,  p.  323. 

8  Foulds,  M.  F. :  Journal  of  the  Royal  Army  Medical  Corps,   December,  1906. 


414  PRACTICAL  HYDROTHERAPY. 

before  each  treatment.  As  a  result  of  the  heat-stroke,  the  patient's 
nervous  system  and  vasomotor  mechanism  have  received  a  severe 
shock,  and  we  often  find  traces  of  injury  to  nerve  functions,  such  as 
headache,  vertigo,  insomnia,  nervous  irritability,  altered  disposition, 
tender  spine,  indigestion,  anemia,  irregularity  of  respiration  and  heart 
action,  morbid  dreads,  mental  excitability,  or  an  incapacity  to  stand 
heat  or  the  sun's  rays.  In  the  after-treatment  it  is  essential,  therefore, 
and  advisable  that  the  patient  be  put  upon  a  light  diet ;  that  he  re- 
frain from  the  eating  of  meat  during  warm  weather ;  that  he  be  com- 
pelled to  drink  daily  at  least  one-half  gallon  of  water;  that  all  diges- 
tive conditions  and  constipation  be  corrected ;  and  that  all  measures 
be  continued  which  will  stimulate  and  regulate  the  nerve  functions 
and  place  him  physically  and  nervously  in  prime  condition.  For  this 
purpose  institutional  treatment  should  be  commenced  immediately 
after  the  attack  and  continued  during  the  period  of  hot  weather  i  nd 
long  into  the  fall  or  winter.  Nothing  is  superior  in  these  cases  to 
the  careful  and  persistent  use  of  the  electric  light  bath  for  several 
minutes,  keeping  the  ice-helmet  on  the  head,  followed  by  the  horizon- 
tal rain  bath  at  100°  F.  for  one  minute,  reduced  to  65°  for  one- fourth 
minute.  As  soon  as  reaction  is  well  established  and  resistance  in- 
creased wc  may  add  the  cold  jet  douche  at  60°  F.  up  and  down  the 
spine,  paying  especial  care  to  the  cervical  region.  In  very  sensitive 
cases  the  electric  light  bath  may  be  omitted  and  the  treatment  $ 
as  outlined,  the  patient  wearing  the  ice-helmet  during  the  rain  bath. 
The  author  has  had  the  pleasure  of  seeing  a  number  of  cases  entirely 
freed  from  unpleasant  sequelae  by  the  adoption  of  these  methods. 

Every  large  city  in  the  Union  has  its  quota  of  heat-  and  sun- 
strokes, and  while  each  city  has  comparatively  few,  considering  the 
population,  still  these  cases  during  the  summer  run  into  the  thousands, 
taking  the  whole  account.  Ambulances  starting  for  cases  of  this 
character  should  be  well  supplied  with  water,  ice  and  an  ordinary 
sprinkling  can,  for  with  this  simple  paraphernalia  great  good  can  be 
done,  pyrexia  reduced  and  much  suffering  averted. 


CHAPTER  XIX. 
MENTAL  DISEASES. 

Mania;  Manic-Depressive  Insanity. 

Mania1  is  a  form  of  insanity  characterized  by  accelerated  flow  of 
ideas,  mental  exaltation  and  motor  excitement.  The  elated  mood  is 
unattended  with  mental  pain,  and  motor  excitement  follows  as  a  re- 
sultant of  the  rapid  flow  of  ideas,  translating  them  into  acts.  It  is 
the  popular  idea  of  mental  disease  or  insanity.  It  is  an  objective  dis- 
ease, easy  to  diagnose,  and  the  antithesis  of  melancholia,  although 
the  attacks  are  usually  preceded  by  a  stage  of  melancholy  and  vague 
unrest. 

Mental  exaltation  is  most  frequent  in  the  young ;  it  represents  the 
natural  exuberance  of  childhood.  What  is  normal  in  the  child  is  ab- 
normal in  the  adult,  and  constitutes  cortical  instability.  Owing  to 
this  unstable  condition  and  tendency  towards  exuberance,  children  are 
more  apt  to  have  febrile  disturbances  or  delirium,  while  peripheral 
irritation  from  such  causes  as  worms  and  indigestion  may  cause  con- 
vulsions. Some  individuals  are  by  inheritance  and  disposition  predis- 
posed to  elation,  just  as  others  have  a  tendency  toward  melancholy, 
and  it  is  certainly  true  that  this  tendency  oftentimes  shapes  itself  into 
forms  or  phases  of  mental  disease. 

In  the  simpler  varieties  of  mania  the  patient  acts  a  great  deal  like 
a  person  under  the  influence  of  a  stimulant,  all  the  various  mental 
operations  being  quickened,  of  a  pleasurable  character  and  diametri- 
cally opposed  to  those  of  melancholia.  To  those  suffering  from  mania 
the  sun  shines  brightly,  the  world  is  rosy-hued,  friends  abound,  and  he 
is  bright,  clever,  smart.  His  capacity  for  conversation  increases  rap- 
idly and  his  brain  is  crowded  with  a  chaos  of  ideas  he  is  unable  to 
control.  He  laughs,  jests,  and  is  jocular  with  his  friends;  is  strong, 
virile,  delighted  with  himself  and  all  things.  If  he  indulges  in  busi- 
ness he  takes  up  many  new  schemes,  writes  many  letters,  his  physi- 
cal activity  being  great,  and  in  many  instances  rushing  from  place  to 
place.  If  carefully  questioned,  however,  some  mental  dullness  is 
detected.  Later  there  is  a  continuous  flow  of  ideas  without  concen- 
tration ;  in  fact,  if  we  attempt  by  various  means  to  hold  his  attention 
and  attract  his  mind  it  will  be  found  that  he  cannot  concentrate  upon 

1  The  author  recognizes  the  modern  classification  of  the  insanities,  especially  the  manic- 
depressive  type,  but  has  adhered  to  the  older  division  because  it  seemed  to  him  to  present 
some  advantage  in  such  a  work  as  this  to  consider  these  states  more  as  separate  entities. 

(415) 


416  PRACTICAL  HYDROTHERAPY. 

any  one  thing  for  a  single  minute.  Oftentimes  a  question  will  start 
a  fresh  outburst.  The  memory  is  wonderfully  accurate,  and  the  atten- 
tion and  observation  so  close  that  nothing  escapes.  To  those  who 
have  observed  mania  it  is  marvelous  how  little  fatigue  is  present. 
Illusions,  hallucinations  and  delusions  are  usually  of  a  pleasant  and 
expansive  character,  and,  generally  speaking,  transitory  in  duration. 
The  sexual  instinct  is  morbidly  increased  in  both  sexes. 

In  the  later  stages  of  the  fully  developed  disease  the  patient  laughs, 
shouts,  howls,  runs  about,  dances,  and  is  dirty  and  filthy  in  his  habits. 
This  mental  excitement  is  accompanied  by  violent  muscular  acts  in 
which  he  may  destroy  property  and  strike  persons.  Profanity  and 
obscenity  occur  with  great  frequency,  even  in  women  who  have  all 
their  lives  been  cultured,  refined  and  surrounded  by  those  influences 
that  would  tend  to  prevent  the  acquisition  of  such  knowledge.  Owing 
to  the  lack  of  mental  control  there  is  an  absolute  loss  of  the  sense 
of  modesty.  Sleeplessness  is  a  prominent  factor  in  these  cases.  The 
skin  is  usually  dry,  the  pulse  increased,  and  a  marked  loss  of  flesh 
takes  place. 

The  usual  causes  assigned  in  the  production  of  mania  are  those 
of  mental  overwork  and  worry ;  physical  or  muscular  overstrain ; 
bodily  ill-health  of  all  kinds,  especially  that  arising  from  indigestion 
and  malnutrition ;  the  various  forms  of  febrile  diseases ;  parturition 
and  surgical  operations.  Here,  again,  an  hereditary  weakness  may 
be  present,  and  if  this  is  coupled  with  mental  stress  and  physical  over- 
strain mania  may  result.  The  pathology  is  unkuown,  there  being  no 
anatomico-pathological  data.  It  therefore  must  be  functional  in  na- 
ture, probably  due  to  some  toxemia  or  interference  with  the  nutrition 
of  the  cortical  neurons.  Recovery  usually  takes  place  in  about  70° 
per  cent,  of  the  cases.  It  is  generally  gradual,  and  in  some  instances 
leaves  behind  a  detectable  defect.  Death  occurs  in  about  5  to  10  per 
cent.,  due  to  exhaustion  or  some  intercurrent  disease,  such  as  pneu- 
monia or  nephritis.  Some  cases  terminate  in  chronic  mania  or  de- 
mentia. The  prognosis  is  in  the  main  favorable,  although  if  the  pa- 
tient does  not  recover  within  the  first  six  to  eight  months  it  is  much 
less  favorable.  After  two  years  the  prognosis  is  bad.  The  younger 
the  patient  the  better  the   chances. 

Few  persons  are  so  situated  as  to  treat  cases  of  mania  in  a  private 
home,  it  being  necessary  in  such  instances  to  not  only  secure  a  suitable 
place,  but  to  have  two  or  three — sometimes  four — trained  nurses  in 
constant  attendance.  The  patient  should,  as  far  as  possible,  be  kept 
in  bed  and  rest  secured,  restraint  being  used  if  necessary.  Forced 
feeding  is  a  necessity,  and  the  author  agrees  with  Clouston2  that  eggs 
and  milk  must  be  given  in  enormous  quantities  if  we  wish  to  succeed 

2  Clouston,   T.    S. :    "Clinical   Lectures  on   Mental   Diseases,"   1884;    "States   of  Mental   Ex- 
altation,"   p.    123. 


MENTAL  DISEASES.  417 

in  restoring  these  patients  to  health.  The  failure  to  secure  the  best 
results  in  asylum  treatment  is  probably  due  to  the  fact  that  patients  do 
not  receive  the  superalimentation  they  deserve  nor  the  careful  atten- 
tion to  the  skin  and  bowel.  Sedatives  must  be  used,  and  of  these  the 
best  is  hyoscin  hydrobromate ;  tonics  should  always  be  given — bitters, 
iron,  hypo-  and  glycerophosphates.  In  the  acute  stages  of  mania 
the  neutral  bath  is  decidedly  the  measure  of  securing  proper  sedation. 
It  is  best  admininstered  by  giving  the  patient  a  hypodermic  of  byoscin 
so  as  to  overcome  bis  struggles  and  objections,  and  as  soon  as  possible 
placing  him  in  the  bath  with  a  cold  turban  upon  the  bead.  It  is  often 
remarkable  to  note  the  beneficial  influences  of  this  form  of  hydro- 
therapy. The  author  shall  never  forget  the  effect  upon  him  of  ob- 
serving the  use  of  the  bath  at  Bethlehem  Hospital  in  London.  At 
that  time  the  neutral  bath  was  not  in  use  among  American  alienists, 
and  as  he  was  just  fresh  from  a  hospital  experience  in  this  line  the 
effect  was  to  him  most  startling.  Since  then  he  has  on  a  number  of 
occasions  been  able  to  secure  most  favorable  sedation  by  this  simple 
measure,  which  can  be  administered  in  almost  any  home.  The  dura- 
tion of  the  bath  should  range  from  thirty  minutes  to  several  hours. 
Its  action  has  previously  been  explained.  When  this  cannot  be  car- 
ried out  we  may  employ  the  full  pack  wrung  out  of  water  at  a  tem- 
perature of  110°  F.  and  the  patient  accurately  and  carefully  enclosed 
therein.  The  duration  of  the  pack  should  range  from  one  to  two 
hours,  and  if  found  effective  may  be  repeated  again  within  eight  to 
twelve  hours.  Sometimes  this  treatment  cannot  be  carried  out  for 
lack  of  facilities,  and  we  may  have  to  resort  to  the  sponge,  placing 
the  patient  between  blankets  and  sponging  with  a  rough  Turkish  bath- 
rag  wrung  out  of  water  at  a  temperature  of  110°  to  120°  F. 

As  convalescence  proceeds  we  may  have  recourse  to  some  of  the 
more,  tonic  or  stimulating  measures,  commencing  with  the  cold  sponge 
at  a  temperature  of  80°  F.,  followed  by  a  vigorous  friction  to  secure 
a  good  reaction.  Reduce  two  degrees  daily  to  70°  F.  Where  possible 
we  should  then  institute  the  electric  light  bath  or  hot-air  bath  until 
free  perspiration  has  been  secured,  followed  by  the  horizontal  or 
circular  rain  bath  at  100°  F.  for  one  and  one-half  minutes,  reduced  to 
70°  F.  for  one-fourth  minute.  This  should  be  followed  by  a  good 
rubbing  and  perfect  reaction.  Hand  in  hand  with  this  treatment  the 
increased  alimentation  should  be  taken  and  fresh  air  and  exercise  se- 
cured. 

Melancholia. 

Melancholia  is  a  mental  disorder  characterized  by  profound  mental 
depression,  mental  distress,  retarded  mental  action,  lessened  motor 
activity,  and  peculiar  facies,  in  some  cases  attended  by  agitation  and 
in  most  by  suicidal  impulses. 


418  PRACTICAL  HYDROTHERAPY. 

The  intensity  of  melancholia  varies,  the  simpler  forms  being  closely 
allied  to  neurasthenia — psychasthenia — although  even  in  these  cases 
there  is  to  the  trained  eye  the  peculiar  expressions  of  pain,  distrust 
and  mental  inactivity.  In  these  simpler  forms  we  find  the  cerebral 
reflexes  lessened ;  that  the  various  sensations,  activity  and  environ- 
ment cause  psychic  pain.  Every  act,  every  thought,  every  impression 
are  no  longer  received  as  agreeable,  but  in  their  passage  through  the 
cerebral  cortex  are  transformed  and  metamorphosed  into  the  mourn- 
ful and  sad. 

Many  individuals  are  by  natural  tendency  psychalgic,  and  this  mel- 
ancholy occurs  transiently  from  varying  causes,  although  we  most 
frequently  find  back  of  it  some  easily  discovered  bodily  condition. 
Certain  types  seem  more  predisposed  to  melancholia  because  of  their 
brains  being  cast  in  finer  mould ;  they  are  sensitive,  high-strung,  of 
a  poetic,  emotional  and  sympathetic  nature,  subject  to  moods  of  a 
depressive  character,  and  oftentimes  reaching  the  borderline  of  true 
melancholia  when  their  physical  well-being  gets  below  par. 

There  is  the  antithesis  of  this  in  the  common  man  and  woman 
of  coarser  mold,  who,  incapable  of  feeling  intense  joy  or  pleasure, 
yet  are  strangely  predisposed  to  take  gloomy  views  of  life,  to  tinge 
their  thoughts  constantly  with  gloom,  to  take  a  so-called  intensely 
religious  view  of  things,  and  to  these  melancholia  frequently  comes, 
owing  to  their  lessened  resistive  power  and  warped  worldly  view. 
These  cases,  in  my  experience,  have  been  especially  prone  to  melan- 
cholia in  later  life  unless  acute  disease  has  not  precipitated  earlier 
attacks.  In  religious  people  melancholia  is  more  difficult  to  cure,  ow- 
ing, in  my  opinion,  to  the  prevalent  false  views  and  terrifying  impres- 
sions these  people  are  apt  to  have,  even  in  health,  of  the  future  life. 
To  these  people  religion  may  actually  be  a  predisposing  factor  in  the 
causation  of  the  melancholia,  and  their  symptoms,  hallucinations,  de- 
lusions and  general  cerebral  action  will  be  tinged  and  colored  by  their 
religious  belief  and  associations.  The  reasoning  powers  are,  as  a  rule, 
intact,  but  in  this  domain  of  cerebral  action  we  will  find  that,  though 
the  melancholic  reasons  well,  his  reasoning  is  slower  than  normal  and 
tinged  with  the  darker  side  of  life.  Melancholies  retain  a  more  normal 
mentality  than  any  other  form  of  mental  disease,  and  it  may  be  stated 
that  theirs  is  the  sanest  form  of  insanity.  Memory  is  usually  well 
retained,  and  even  in  bad  cases,  as  soon  as  attention  is  secured,  accu- 
rate answers  to  interrogatories  can  be  made.  These  are  the  patients 
across  whose  face  there  never  flits  a  smile — that  wonderful  illumi- 
nating light,  a  reflex  of  the  soul  within — and  as  everything  is  trans- 
formed into  mental  pain  it  is,  for  this  reason,  a  great  mistake  for 
friends  and  relatives,  in  their  well-meaning  endeavors,  to  "jolly  up" 
and  cheer  a  melancholic. 

Melancholia  is  present  more  frequently  in  females  than  in  males, 


MENTAL  DISH.  IS  US.  419 

and  this  is  not  due  to  the  presence  of  the  pelvic  viscera,  for  although 
pelvic  lesions  may  cause  melancholia,  it  should,  in  passing,  be  noted 
that  the  correction  by  operation  or  otherwise  of  the  condition  does 
not  cure.  Heredity  will  be  found  in  about  half  of  the  cases.  Physical 
ill-health,  over-strain,  mental  worry  and  distress  are  powerful  factors, 
and  it  may  be  said  that  where  defective  heredity  is  present,  accom- 
panied by  physical  ill-health  and  over-strain,  supplemented  by  mental 
worry  and  distress,  we  have  the  great  tripod  upon  which  melancholia 
is  built.  In  younger  cases  any  great  depreciation  of  the  general  health, 
acute  infectious  diseases,  love  affairs,  with  the  novel  stresses  and  ex- 
citing incidents  thereto,  may  oftentimes  produce  the  disorder.  One 
of  the  most  important  causes  present,  in  my  opinion  more  frequently 
than  any  other,  is  auto-intoxication  arising  from  the  gastro-intestinal 
tract. 

The  diagnosis  of  melancholia  is  usually  easy,  being  based  upon 
the  melancholy,  mental  distress,  the  presence  of  the  peculiar  facies, 
persistent  insomnia,  post-cervical  ache,  hallucinations,  delusions,  etc. 
Melancholia  runs,  as  a  rule,  a  slow  course,  estimated  by  most  authori- 
ties who  deal  with  asylum  cases  at  from  six  months  to  two  years. 
This  duration  is  probably  to  be  accounted  for  by  the  fact  that  melan- 
cholies placed  in  asylums  receive  largely  custodial  care,  and  not  that 
individualized  attention  that  is  necessary  to  their  cure. 

In  my  personal  observations  and  experience  the  treatment  has 
ranged  from  two  to  four  months  in  simple  melancholia.  The  recov- 
ery is  usually  gradual,  and  as  convalescence  takes  place  a  betterment 
of  the  physical  health  is  noticed.  Recovery  takes  place  in  from  85  to 
90  per  cent,  of  the  cases.  For  some  time  after  patients  reach  a  suffi- 
ciently normal  state  to  return  home  and  to  their  occupations  we  can 
frequently  detect  a  slight  incapacity  for  intellectual  effort  where  com- 
plicated problems  or  conceptions  require  quick  judgment.  Deaths 
in  melancholia  are  most  frequently  due  to  suicide,  inanition,  pneu- 
monia, and  in  long-drawn  cases  to  tuberculosis.  The  prognosis  is  favor- 
able, less  so  in  the  agitated  and  catatonic  types.  Relapses  are  apt  to 
occur  unless  the  case  is  watched  a  sufficient  length  of  time  after  dis- 
missal. The  rule  in  the  management  of  cases  of  melancholia  should 
be  never  to  commit  a  case,  if  possible,  to  the  asylum,  owing  to  their 
inability  to  secure  the  individual  attention  so  necessary.  They  should 
be  given  private  care,  best  in  small  sanatoria,  in  this  way  combining 
every  advantage  of  treatment  and  avoiding  the  stigma  of  the  mental 
hospital.  The  asylum  should  be  the  last  resort  for  those  who  are 
able  to  secure  other  treatment,  or  only  when  the  violence  of  the  case 
demands  it. 

In  the  treatment  of  melancholia  it  is  most  important  that  we  should 
at  once  isolate  the  patient.  By  so  doing  we  remove  him  from  his  old 
environment,  where  familiar  faces  and  surroundings  tend  to  cause  a 


420  PRACTICAL  HYDROTHERAPY. 

recurrence  of  the  same  ideas ;  it  separates  him  from  the  sympathetic 
and  foolish  relatives  and  friends,  who  have  the  idea  that  he  should 
he  cheered  up  and  entertained.  These  cases  are  nervous  and  irri- 
table, and  this  disappears  frequently  immediately  after  isolation  is 
completed.  It  is  essential  to  have  a  nurse  with  such  cases  in  order 
that  mental  and  moral  control  may  be  exercised.  Rest  of  body  is  a 
very  valuable  adjunct  in  connection  with  the  other  treatment.  Trav- 
eling is  frequently  recommended,  but  traveling  and  amusement  are 
painful  to  the  patient,  and  are  of  no  value  until  recovery  has  taken 
place.  For  the  same  reason  health  resorts  do  not  help  the  melancholic, 
but  when  recovery  has  taken  place  and  further  rest  seems  advisable, 
we  ma}-  in  summer  recommend  the  coast  of  Maine,  the  Great  Lakes, 
and  in  winter.  Florida,  California,  the  Bermudas,  Asheville.  etc. 

Food  should  be  administered  in  large  quantities ;  in  fact,  super- 
alimentation is  necessary,  and  to  this  end  we  may  use,  in  addition 
to  the  ordinary  meals,  milk,  koumyss,  matzoon,  plasmon,  raw  eggs, 
meat  juice,  malt,  and,  if  necessary,  stimulants.  Forced  feeding  is 
the  rule  for  these  cases.  A  careful,  attentive  and  conscientious  nurse 
forms  an  important  element  in  the  treatment.  It  is  important  to  care- 
fully regulate  the  constipation  and  secure,  if  possible,  intestinal  anti- 
sepsis. Hydrotherapy  plays  a  most,  if  not  the  most,  importanf  part 
in  the  management  of  these  cases,  for  through  its  influence  we  secure 
a  powerful  tonic,  eliminant  and  reconstructive  influence.  As  a  rule, 
the  blood  pressure  in  melancholic-  is  usually  high,  and  for  that  reason 
we  should  slowly  train  these  cases  to  stand  cold  water,  avoiding  very 
cold  baths  and  prolonged  cool  applications. 

The  hydrotherapeutic  treatment  of  melancholia  may  be  divided 
<s — that  which  can  be  administered  in  the  home  and  in- 
stitutional methods.  Many  cases  of  melancholia  can  be  successfully 
treated  in  the  private  home  if  proper  measures  are  instituted.  In 
addition  to  all  that  has  been  previously  said,  we  may  commence  the 
treatment  of  the  case  with  the  cold  sponge  at  a  temperature  of  90° 
F.,  reducing  the  temperature  two  degrees  daily  until  70°  F.  is  reached, 
care  being  taken  to  follow  the  application  of  the  sponge  by  vigorous 
friction  with  a  crash  towel.  Some  patients  seem  to  be  improved  by  a 
subsequent  oil  rub,  which  is  probably  due  not  so  much  to  the  oil  as 
to  the  rubbing  or  massage.  As  soon  as  the  patient's  reaction  has  been 
slightly  trained  we  may  move  up  a  notch  to  the  dripping  sheet  at  a 
temperature  of  70°  F.  for  three  minutes,  applied  with  vigorous  fric- 
tion, while  the  patient  stands  in  a  foot-tub  of  very  hot  water.  Care 
should  be  taken  to  see  that  the  proper  reaction  is  secured.  Immedi- 
ately following  the  sheet  the  patient  should  be  put  to  bed  and  given 
food,  preferably  hot  milk.  This  treatment  is  best  administered  in 
the  morning  before  breakfast,  and  as  these  cases  suffer  so  persistently 
from  insomnia  in  conjunction  with  the  dripping  sheet,  the  full  pack 


MENTAL  DISEASES.  42\ 

may  be  given,  preferably  at  bedtime.  The  author  generally  commences 
with  a  temperature  of  80°  F.  for  forty  to  sixty  minutes,  reducing  the 
temperature  two  degrees  nightly  until  60°  F.  is  reached,  at  which 
point  it  is  maintained.     After  the  patient  has  been  in  the  pack  for  one 

hour  he  is  removed,  quickly  dried  without  securing  reaction,  given  a 
glass  of  hot  milk,  and  if  necessary  a  hypnotic.  This  treatment  has  in 
most  cases  broken  up  the  most  persistent  insomnia.  Where  the  pack 
cannot  be  administered — and  this  is  most  frequently  due  to  the  fact 
that  the  physicians  and  nurses  do  not  understand  its  application — 
we  may  use  the  neutral  full  bath  at  a  temperature  of  94°  to  96  F. 
for  thirty  minutes,  increasing  the  duration  five  minutes  nightly  until 
the  patient  remains  in  the  bath  a  full  hour.  Where  this  cannot  be 
utilized  a  hot  and  cold  spinal  sponge  in  conjunction  with  the  hypnotic 
will  oftentimes  marvelously  enhance  its  action  and  enable  the  physi- 
cian to  give  a  smaller  dose.  The  above  measures  are  within  the  reach 
of  any  intelligent  physician  who  cares  to  take  the  time  and  trouble  to 
carry  them  out. 

Institutional  treatment  is  by  far  the  most  successful  and  beneficial 
as  it  places  the  patient  under  the  most  favorable  circumstances  of 
isolation  and  enables  the  treatments  to  be  administered  by  physicians 
and  nurses  who  are  well  acquainted  with  the  application.  The  author 
divides  the  sanatorium  treatment  of  these  cases  into  those  who  are 
bed-ridden  and  those  who  are  ambulatory.  In  the  former  the  same 
treatment  as  outlined  for  the  private  home  is  utilized.  Where  the 
case  is  up  and  about  we  may  commence  at  once  the  use  of  the  electric 
light  bath  or  hot  air  bath  until  free  perspiration  takes  place,  followed 
by  the  horizontal  rain  bath  at  100°  to  104°  F.  for  one  and  one-half 
minutes,  reduced  to  80°  for  one-half  minute;  reduce  two  degrees 
daily  to  70°  F.  As  soon  as  this  point  has  been  reached  give  the  fore- 
going treatment,  and  in  addition  add  the  jet  douche  to  the  spine  at 
70°  F.  for  ten  seconds.  In  addition  to  this  treatment  we  may,  if  the 
insomnia  remains  persistent,  add  the  neutral  bath  at  bedtime  or  the 
hot  and  cold  spinal  sponge.  For  the  loss  of  appetite  the  free  drinking 
of  cold  water  and  the  administration  of  the  ice-bag  to  the  epigastrium 
for  half  an  hour  before  meals  is  an  excellent  method.  The  writer  has 
seen  cases  of  melancholia  improve  before  the  end  of  the  first  week 
under  this  treatment.  In  addition,  it  is,  of  course,  understood  that  the 
bitter  tonics,  glycerophosphates,  the  nitrates,  opium  and  codeine  may 
be  administered  if  needed. 

When  convalescence  is  established  occupation  in  the  open  air  or 
some  such  exercise  as  driving,  golfing,  the  study  of  natural  history 
or  botany  may  be  followed  with  great  advantage.  Associated  measures 
that  oftentimes  materially  aid  in  helping  the  case  are  massage  and  the 
different  forms  of  electricity. 


422  PRACTICAL  HYDROTHERAPY. 

Confusional  Insanity. 

The  Exhaustion  Psychoses;  Acute  Delirium;  Acute  Dementia; 
Primary  Dementia;  Infection  Psychoses;  Febrile  Delirium;  Kor- 
sakoff's Psychosis;  Post-Febrile  Insanity;  Toxic  Psychoses; 
Alcoholic,  Morphine,  Cocaine  and  other  Drug  Insanities;  Post- 
operative Insanity. 

Confusional  insanity  is  a  general  term  used  to  designate  a  group 
of  psychoses  characterized  by  marked  confusion  and  attended  with 
quickly  changing  illusions,  hallucinations  and  unsystemized  delusions, 
in  the  course  of  which  excitement,  depression,  mental  enfeeblement 
and  stupor  may  take  place.  An  essential  element  in  the  disease  is  a 
mental  confusion  that  dominates  the  course  of  the  malady.  The 
illusions,  hallucinations  and  delusions  are  rapidly  changing,  so  that 
there  is  present  a  constant  varying  ideation,  phantasmagoric  in  char- 
acter, without  any  relation  or  system.  In  these  two  ways  this  disease 
is  the  reverse  of  paranoia.  The  intensity  of  the  disease  varies  from 
a  condition  where  the  patient  can  give  true  and  accurate  accounts  of 
his  hallucinations  and  delusions  to  conditions  of  exhaustion  and 
stupor  that  render  him  incapable  of  intelligent  response.  The  disease 
is' usually  found  in  the  active  period  of  life,  most  often  between 
twenty-five  and  fifty,  occurring  more  frequently  in  men.  There  is 
probably  less  heredity  basis  in  this  form  of  insanity  than  any  other 
of  the  psychoses.  This  cannot  be  said  of  those  cases  of  alcoholism 
and  drug  habituation,  who  usually  have  a  neurotic  basis  back  of  the 
disorder.  Attention  is  called  here  to  the  difference  between  mor- 
phinism and  the  allied  drug  habits  without  any  mental  disease  and  the 
confusional  insanity  that  develops  with  them  as  a  causal  factor.  The 
author  has  found  typhoid  fever,  grippe  and  alcoholism  to  be  the  most 
frequent  individual  causes.     The  disease  is  best  described  as  follows : 

"On  recovering  from  a  shorter  or  longer  febrile  state  the  patient 
begins  to  show  signs  of  irrationality  and  mild  delirium.  This  may  end 
in  an  attack  of  acute  delirium.  When  this  exists,  the  mind,  instead 
of  clearing,  becomes  clouded  and  confused.  There  are  now  hallucin- 
ations of  sight  or  hearing,  with  various  unstable  delusions,  especially 
as  regards  the  place  he  is  in  and  the  people  about  him.  He  'talks 
incoherently  at  times,  describing  things  on  the  wall  or  people  in  the 
room,  or  appears  to  hear  voices  and  people  outside.  At  times  he  may 
be  so  excited  that  he  tries  to  get  out  of  bed  and  has  to  be  restrained. 
His  lack  of  orientation  and  defects  of  memory  are  great,  and  he  will 
insist  that  he  was  walking  on  the  previous  day  or  has  received  visitors 
whom  he  has  never  seen.  He  often  responds  well  to  direct  and  simple 
inquiries,  and  at  times  seems  fairly  lucid,  but  soon  lapses  into  in- 
coherence. If  quite  ill  physically,  the  confusion  and  irritability  are 
shown  in  the  low  delirium,  which  is  worse  at  night.  He  sleeps  badly, 
and  is  at  night  especially  apt  to  be  disturbed  by  his  hallucinations  and 
illusions.  The  confusion  may  be  so  great  that  he  fails  to  respond 
sensibly  to  any  inquiries.     After  a  few  weeks,  or  perhaps  a  few  days, 


MENTAL  DISEASES.  423 

the  mind  begins  to  clear,  the  delusions  and  hallucinations  disappear, 
and  there  is  lucidity  of  thought  and  response.  But  for  some  time  the 
mind  is  weak,  thought  is  slow  and  memory  defective,  and  there  may 
be  some  apathy  and  depression."8 

The  convalescence  is,  as  a  rule,  in  these  cases  generally  preceded 
by  a  mild  form  of  dementia,  recovery  generally  taking  place  by  gradual 
diminution  of  the  symptoms.  The  duration  of  the  disease  varies  from 
a  few  days  to  five  or  six  months,  although  the  general  course  is 
usually  short,  ranging  from  four  to  ten  weeks.  The  prognosis  is,  as 
a  rule,  favorable,  especially  so  if  the  patient  can  be  subjected  to  the 
proper  treatment  and  nursing  and  if  the  treatment  is  instituted  early 
in  the  course  of  the  disease.  The  patient  usually  recovers  from  the 
psychosis,  provided  the  bodily  disease  or  febrile  disturbance  from 
which  he  is  suffering  does  not  cause  death.  The  above  favorable 
prognosis  does  not  apply  to  acute  grave  delirium,  Korsakoff's  psy- 
chosis, nor  to  those  who  are  in  an  extremely  exhausted  condition. 

Depressing  drugs  should  be  avoided  wherever  possible,  and  hy- 
oscin,  trional,  sulfonal,  et  al.,  given  in  the  smallest  possible  doses. 
Tonics  and  supporting  treatment,  especially  strychnine  and  cardiac 
tonics,  should  be  administered.  As  a  rule,  it  may  be  stated  that  the 
more  hydrotherapy  is  employed  the  less  medicine  will  be  used.  This 
does  not  apply  to  tonics. 

The  essential  element  in  the  treatment  of  confusional  insanity  is 
super-alimentation,  careful  nursing,  and  the  elimination  of  the  toxic 
or  autotoxic  poisons  upon  which  the  psychosis  depends.  In  the 
treatment  of  confusional  insanity  it  is  best  to  isolate  the  patient,  placing 
him  in  the  charge  of  a  couple  of  well-trained  nurses.  The  family, 
sympathetic  relatives  and  friends  should  be  forbidden  in  the  room 
until  the  patient's  recovery  is  well  assured.  Rest  of  body  and  mind, 
as  far  as  possible,  is  a  necssary  adjunct  in  connection  with  the  other 
treatment.  These  cases  should  be  kept  as  quietly  in  bed  as  possible, 
and  every  remedy  of  a  depressing  character  withheld.  The  author 
is  of  the  opinion  that  food  is  one  of  the  best  sedatives  that  can  be 
given,  and  should  be  administered  in  large  quantities,  insisting  upon 
three  meals  daily  with  two  to  three  quarts  of  milk  or  an  equivalent 
of  koumyss,  plasmon,  raw  eggs,  meat  juices,  etc.  Malt  extracts  will 
be  found  of  some  value ;  stimulants  are  at  times  demanded.  It  will 
be  necessary  with  the  increased  feeding  to  watch  carefully  the  di- 
gestion and  administer  laxatives.  In  the  author's  opinion  hydro- 
therapy alone  is  sufficient  to  bring  about  a  cure  when  used  in  con- 
junction with  the  hygienic  and  dietetic  management.  The  application 
of  hydrotherapy  requires  thought  and  adaptation  of  measures  to  the 
particular  case  in  hand.     In  many  cases,  had  hydrotherapy  been  insti- 

3  Dana,  C.  L. :  "Text-Book  of  Nervous  Diseases  and  Psychiatry,"  1904  Confusional 
Insanity,    p.    652. 


424  PRACTICAL  HYDROTHERAPY. 

tuicd  during  the  febrile  or  causative  trouble  the  chances  arc  that  the 
psychosis  might  have  been  avoided.  The  psychosis  once  established, 
the  aim  of  hydrotherapy  is  to  favor  elimination,  tone  up  the  nervous 
system,  increase  and  equalize  the  circulation,  improve  the  appetite 
and  digestion,  lessen  nervous  irritation  and  excitement,  and  induce 
sleep.  We  should  commence  in  these  cases  as  though  they  were  being 
treated  for  some  serious  febrile  disease.  The  patient  is  disrobed  and 
placed  between  blankets,  the  first  treatment  being  that  of  the  cold 
sponge,  commencing  at  a  temperature  of  90°  F.  and  treating  the  body 
in  sections  as  described  in  a  previous  chapter.  The  temperature  of 
the  water  may  be  reduced  two  degrees  daily  until  70°  to  60°  F.  is 
reached.  This  treatment  may  be  administered  twice  daily,  or,  what 
is  far  better,  administered  in  the  early  morning  and  mid-afternoon, 
and  at  night  the  full  wet  pack,  commencing  with  a  temperature  of 
80°  F.,  reducing  the  temperature  two  degrees  daily  to  65°  F.  Where 
it  is  difficult  to  manage  the  patient  and  the  wet  pack  for  this  reason 
cannot  be  used,  we  should  substitute  the  hot  and  cold  spinal  sponge, 
which  will  produce  sleep.  Where  the  patient  is  exhausted  it  will 
probably  be  found  impossible  to  do  more  than  use  the  sponging,  which 
may  be  followed  in  such  cases  either  by  an  alcohol  or  oil  rub.  It  has 
been  the  author's  experience  that  the  nearer  we  hew  to  the  line  of  the 
strict  and  full  rest  cure,  which  has  previously  been  described,  the 
better  will  be  the  success  and  the  quicker  the  recovery. 

Should  heart  failure  seem  imminent  or  the  blood  pressure  mark- 
edly decreased,  the  ice-bag  to  the  precordial  region  will  be  found  a 
measure  of  exceptional  benefit.  The  author  has  learned  to  lean  too 
frequently  upon  this  support  not  to  know  the  value  of  the  remedy. 

Headache  is  best  met  by  the  application  of  the  fomentation  to  the 
forehead,  followed  by  the  cephalic  compress  at  a  temperature  of  60° 
F.,  renewing  same  as  frequently  as  may  be  necessary.  The  ice-bag  to 
the  nape  of  the  neck  will  also  assist  in  relieving  this  condition. 

Insomnia  is  best  combated  by  means  of  forced  feeding  and  hydro- 
therapy. An  egg-nog  or  large  glass  of  hot  milk  immediately  following 
the  wet  pack  will  oftentimes  produce  sleep  without  the  hypnotic,  or 
where  this  cannot  be  obtained  small  doses  of  trional  or  veronal  may 
be  administered. 

Mental  excitement  and  motor  restlessness  may  require  the  use  of 
the  full  warm  bath  (98°  to  100°  F.)  for  thirty  to  sixty  minutes, 
though  this  is  probably  best  combated  by  the  cold  sponging,  rest,  and 
over-feeding.  Restraint  may  be  required.  Should  ordinary  measures 
fail,  the  treatment  for  mania  may  be  subsituted. 

Etiological  factors  must  always  be  considered  and  treated.  In 
those  cases  where  puerperal  sepsis  is  present,  curettement  should  be 
performed  and  hot  vaginal  douches  instituted.  Any  febrile  disease 
acting  as  a  causative  agent  must  have  its  quota  of  consideration  in 


MENTAL  DISEASES.  425 

adapting  the  treatment  to  the  particular  case  in  hand.     For  this  in- 
formation  the  reader  should   refer  to  the   sections  in   which    febrile 

diseases  are  considered. 

As  soon  as  convalescence  is  established  we  may  begin  to  use  some 

of  the  mure  active  hvdn -therapeutic  measures,  and  none  wil  be  found 
more  generally  applicable  than  the  dripping  sheet  at  a  temperatu 
60°  F.  for  three  minute-,  accompanied  with  vigorous  friction,  while 
the  patient  stands  in  a  hot  foot-bath.  Vigorous  reaction  is  desired. 
At  this  time  the  full  wet  pack  at  60°  F.  for  one  hour  at  bedtime  will 
increase  metabolism,  relieve  excitability  and  induce  sleep.  As  soon 
as  the  patient  is  up  and  about  institutional  treatment  should  be  at 
once  adopted,  and  to  this  end  we  may  give  the  electric  light  bath  or 
ir  bath  until  perspiration  take-  place,  followed  by  the  rain  bath 
at  104°  for  one  and  one-half  minutes,  reduced  to  60°  F.  for  ten 
T!ie  hydriatist  will  have  to  exercise  caution  in  these  cases 
in  the  use  of  the  spray  and  jet  douche-,  and  should  not  use  them 
until  the  patient  has  progressed  well  on  the  road  to  recovery.  It 
should  be  the  aim,  however,  to  reach  this  point  at  the  earlie.-t  possible 
moment  consistent  with  safety.  The  following  treatment  may  then 
be  employed:  Electric  light  bath  until  profuse  perspiration  takes  place. 
horizontal  rain  bath  at  a  temperature  of  104"  F.  for  one  and  one-half 
minutes,  pressure  twenty-five  pounds,  reduced  to  60°  F.  for  ten  seconds, 
followed  by  the  briefest  possible  spray  douche  to  the  body  and  jet  to 
the  spine  at  a  temperature  of  60°  F. 

Recovery  having  taken  place,  the  treatment  should  not  be  discon- 
tinued at  once,  but  must  be  maintained  for  several  months  in  order 
to  overcome  exhaustion  or  any  toxic  condition.  The  patient  must 
avoid  all  worry  or  physical  strain,  taking  sufficient  exercise  in  the 
open  air  of  a  gentle  character,  of  which  driving  and  golfing  are  the 
best  measures.  Increased  feeding  must  be  maintained.  If  possible 
the  case  should  summer  for  several  months  on  the  Maine  coast  or  the 
Great  Lakes;  or  in  winter  California,  Florida,  North  Carolina  moun- 
tains, Bermudas,  etc.,  may  be  utilized. 

Paranoia. 

Chronic  Delusional  Insanity:  Monomania;  Folic  Raisonnantc;  Primare 

Verruecktheit. 

Paranoic  is  a  chronic  progressive  psychosis  developing  soon  after 
maturity,  and  characterized  by  logical  and  systemized  delusions  of, 
first,  persecution,  and  later  those  of  self-exaltation  or  grandeur,  with- 
out excitement,  emotion,  ideation  or  impairment  of  memory.  The  most 
important  factor  in  this  disease  is  that  of  heredity ;  this  may  be  direct 
or  indirect.  Krafft-Ebing  believes  that  there  is  never  a  case  without 
hereditary  taint.     It  occurs  oftener  in  men  than  in  women,  according 


426  PRACTICAL  HYDROTHERAPY. 

to  the  majority  of  authors,  though  my  experience  has  been  the  reverse. 
It  occurs  most  frequently  between  twenty  and  forty,  and  affects  in- 
dividuals who  from  childhood  have  exhibited  many  peculiar  morbid 
conditions.  The  cases  often  present  stigmata  of  degeneration,  espe- 
cially malformations  of  the  cranium,  ear  and  palate. 

The  childhood  of  the  paranoiac  is  usually  marked  by  peculiarities 
and  eccentricities.  The  companionship  of  others  is  avoided,  they  are 
morbidly  shy,  mistrustful,  irritable,  oftentimes  seeking  solitude. 
Egotism  is  especially  apt  to  be  prominent,  as  also  is  selfishness — 
expecting  much,  giving  little.  The  effect  of  puberty  and  adolescence 
is  to  increase  the  proclivities  already  present  and  to  bring  out  posi- 
tively and  more  clearly  the  incapacity  of  the  patient.  As  further 
growth  and  development  take  place  the  patient  begins  to  realize  that 
he  is  different  from  the  average  individual  about  him,  and,  watching 
his  symptoms  more  closely,  becomes  morbidly  introspective,  both  as 
regards  bis  bodily  sensations  and  the  rush  of  peculiar  ideas  through 
his  mind.  These  are  the  cases  that  usually  form  the  large  group 
commonly  designated  "cranks."  They  are,  as  a  rule,  immature  or 
abortive  forms  of  paranoia,  conditions  that  are  rarely  carefully  studied 
for  their  morbid  psychology  except  by  the  specialist. 

Built  upon  the  hereditary  basis  above  mentioned,  the  disease  is 
generally  of  insidious  origin.  The  early  period  is  associated  with 
depression  and  delusions  of  persecution,  which  at  the  inception  of 
the  trouble  irritate  and  distress  the  individual,  who  oftentimes  calls 
his  delusions  into  question.  As  time  passes  on  the  delusions  become 
more  or  less  fixed,  and  the  individual  then  "lives  in  the  atmosphere 
of  suspicion ;  everything  to  him  has  a  covert  meaning,  and  'trifles  light 
as  air  become  as  proof  of  Holy  Writ.'  Indeed,  Shakespeare's  de- 
scription of  Othello's  jealousy  is  and  excellent  picture  of  what  is  often 
seen  in  paranoiacs."4  It  is  upon  this  basis  of  persecution  that  he 
builds  his  expansive  and  grandiose  delusions,  arguing  that  if  he  is 
watched  and  persecuted  he  must  be  someone  worthy  of  the  perse- 
cution, and  in  his  morbidly  logical  mind  he  exalts  himself  far  above 
his  class.  It  is  sometimes  astonishing  to  note  the  clearness,  accuracy 
and  forcefulness  of  memory,  judgment  and  reasoning  power  of  these 
individuals,  for,  if  the  premise  is  granted,  the  reasoning  is  carried  to 
an  almost  perfect  consummation.  So  remarkable,  indeed,  is  this 
quality  of  the  paranoiac  that  it  is  incomprehensible  to  the  lay  mind 
that  such  an  individual  can  be  insane.  These  patients  form  one  of 
the  most  dangerous  classes  of  the  insane,  for,  acting  under  the  impress 
of  their  delusions,  with  their  judgment  and  mental  capacity  unim- 
paired, save  in  certain  directions,  they  are  capable  of  performing  most 
cold-blooded  acts,  which  bear  upon  them  the  impress  of  a  total  lack 
of  the  ethical  sense. 

4  Gray,  L.  C. :   "Nervous  and  Mental  Diseases,"   1893.     Paranoia,  p.  633. 


MENTAL  DISEASES.  427 

The  delusions  and  hallucinations  that  these  cases  take  up  are 
without  limit,  and  to  attempt  to  name  many  of  them  would  he  foreign 
to  this  work.  Suffice  it  to  say  that  many  take  up  ideas  about  elec- 
tricity, the  telephone,  phonograph  and  other  similar  lines.  Many 
paranoiacs  have  attempted  homicide  under  their  delusions  of  persecu- 
tion, the  most  notable  of  whom  were  Norcross ;  others  believe  that 
they  are  the  lover  or  the  loved  of  some  notable  or  prominent  person, 
such  as  Dougherty,  who  followed  Mary  Anderson  all  over  the  country. 
The  same  man  shot  Dr.  Loyd,  of  the  Flat  Bush  Asylum.  Many  of 
these  cases  are  fond  of  litigation,  which  may  arise  out  of  some  previous 
loss  of  property  or  injury  to  reputation  by  lawsuits.  One  of  the  most 
common  of  the  delusive  states  is  that  of  a  great  inventor.  The  author 
personally  is  aware  of  such  an  instance  in  his  own  experience,  that 
was  exceedingly  distressing  as  well  as  unpleasant.  "Many  paranoiacs 
have  distinguished  themselves  in  sacred  and  profane  history,  and  even 
in  literature.  There  have  been  many  false  prophets  who  have  come 
to  herald  a  new  religion — Mahomet,  Swedenborg,  Johanna  Southcoot, 
Jeanne  d'Arc.  We  have  had  them  in  the  United  States  within  a  few 
years — the  healers,  exploited  by  the  press.  Among  the  political  re- 
formers we  have  had  John  Brown,  Guiteau  and  Czolgocz."5 

The  pathology  is  without  anatomical  basis,  no  changes  having  been 
as  yet  detected  with  the  means  we  have  at  hand  for  investigation. 
Gross  anomalies  exist.  Dana0  suggests  that  there  are  probably  certain 
defects  in  the  normal  arrangement  of  the  projection  system  and 
associated  paths. 

The  prognosis  is  almost  uniformly  unfavorable,  no  patient  ever 
recovering.  Remissions  occur  in  the  disease,  and  the  patient  may 
reach  a  fairly  normal  state  and  remain  so  for  a  number  of  years,  pro- 
viding his  surroundings  are  suitable.  Usually,  however,  these  cases, 
after  reaching  a  marked  delusional  stage,  become  excitable  and  dan- 
gerous in  their  actions,  and  at  this  time  are  generally  removed  to  an 
institution.  Here  they  gradually  quiet  down,  and  under  restraining 
influence  and  care,  with  the  freedom  from  irritation  that  is  found  in 
institutional  life,  may  live  to  an  advanced  age,  and  retain  during  this 
time  a  fairly  rational  condition.  This  breaks  down  whenever  he  is 
subjected  to  the  trials  and  strains  of  a  return  to  active  life. 

In  the  treatment  of  this  disease  the  endeavor  should  be  to  bring 
about  the  most  satisfactory  environment  possible — that  is  to  say,  rest, 
quiet,  freedom  from  worry  and  care,  with  little  excitement  and  strain 
upon  the  individual.  He  should  be  given  regular  outdoor  life, 
occupation  sufficient  to  keep  him  physically  tired,  which  Vill  probably 
do  more  to  prevent  the  constant  recurrence  of  his  ideas  than  almost 
any   other   method   of   treatment.      Some   amusement   and    recreation 

5  Church  and  Peterson:   "Nervous  and   Mental   Diseases,"   1899.     Paranoia,  p.   743. 

6  Ibidem,    p.    354. 


428  PRACTICAL  HYDROTHERAPY. 

are  essential,  although  labor  should  be  the  principal  element  in  his 
management.  It  acts  as  a  mental  counter-irritant.  Everything  should 
be  done  to  build  up  the  general  health,  and  to  this  end  the  electric 
light  bath  or  hot-air  bath,  favoring  as  it  does  elimination  and  recon- 
struction, followed  by  the  circular  or  horizontal  rain  bath  at  100°  to 
102°  F.  for  one  and  one-half  minutes,  pressure  twenty-five  pounds, 
gradually  reduced  to  60°  F.,  administered  daily,  will  oftentimes  aid 
in  bringing  about  a  remission  and  maintaining  it.  Where  the  patient 
becomes  excitable  and  nervous  the  neutral  bath  at  94°  to  96°  F.  for 
twenty  to  sixty  minutes  oftentimes  proves  most  effective. 

The  true  treatment  of  the  paranoiac  should  be  that  of  prevention, 
and  while  treatment  may  not  altogether  prevent  the  occurrence  of 
the  disease,  it  may  so  modify  and  restrain  its  development  as  to  place 
the  case  in  the  simpler  category  of  "crank."  To  this  end  the  child 
should  be  treated  along  the  general  lines  laid  down  in  another  section 
of  this  work  (The  Rearing  of  the  Neuropathic  Child).  It  is  to  be 
regretted  that  parents,  guardians,  teachers  and  those  who  have  the 
custodial  care  of  children  do  not  pay  more  attention  and  caie  during 
the  tender  years  of  childhood  to  the  preventive  feature  of  future 
neural  and  psychic  disease.  The  author  is  constrained  to  believe  that 
the  fault  lies  at  the  door  of  the  family  physician,  whose  practice  and 
intimacy  with  the  family  during  the  rearing  of  the  immature  and 
mouldable  child  is  oftentimes  so  close  that  he  could,  by  his  guidance 
and  suggestions,  prevent  future  trouble  by  instituting  the  proper  hy- 
giene, diet,  exercise  and  other  measures  mentioned. 

Dementia  Precox. 

Dementia  precox  is  the  generic  name  applied  to  certain  mental  dis- 
eases, observed  more  particularly  in  the  male  sex,  appearing  usually 
before  adolescence  is  complete.  It  is  a  disease  that  runs  a  long  course, 
and  is  characterized  by  silliness,  some  mental  excitement,  delusional 
and  stupid  states,  motor  disorders,  and  progressive  mental  exhaustion, 
terminating  usually  in  dementia.  These  cases  are  apt  to  be  con- 
founded with  neurasthenia  and  hysteria,  from  which  they  should  be 
carefully  differentiated.  It  is  a  disease  of  the  developmental  period 
of  life,  usually  before  the  age  of  twenty  to  twenty-five  years.  There 
may  or  may  not  be  an  inherited  history,  but  the  consensus  of  opinion 
is  that  the  disease  is  due  to  a  congenital  defect  of  some  kind.  Neu- 
roses, drug  habits  and  alcoholism  in  the  parents  can  oftentimes  be 
traced.  The  ideas,  actions  and  mental  peculiarities  of  these  cases  are 
moulded  and* formed  under  the  influence  of  thousands  of  impressions 
streaming  into  the  developing  brain  of  the  adolescent  just  after  puberty. 
The  enormous  influence  of  the  development  of  the  sexual  function 
and  the  stimulation  of  the  emotional  side  of  one's  nature,  that  in- 
variably  accompanies   its   establishment,   leaves   an   impress   upon   the 


MENTAL  DISEASES.  429 

mind  and  brain  of  the  healthy  individual  long  to  be  remembered,  and 
upon  the  unstable  organism  its  action  is  intense.  Into  the  life  of  the 
individual  conic  new  ideas,  new  interests,  new  thoughts,  new  cravings, 
new  delights,  and  over  all  there  is  thrown  a  glamour,  a  tinselry,  a  love 

and  a  romance  that  is  known  at  no  other  period. 

I  lercditary  tendency  is  strong  in  these  cases,  but  the  factor  of  great 
importance  is  the  question  of  environment  and  rearing  of  these  chil- 
dren, neuropathically  inclined  from  birth.     Too  often  we  can  ohserve 
that   the  parents  are  unable  to  master  or  control  themselves,  and  it 
hardly   stands   to  reason,   therefore,   that   they   can   by   example  and 
precept  control  those  whom  they  have  brought  into  the  world.     The 
pedagogue  to  whom  the  care  of  the  adolescent  of  neuropathic  tenden- 
cies is  committed  should  he  the  one  to  appreciate  the  need  of  not  over- 
straining the  weakest  point.     They  really  need  more  than  instruction, 
for  it  is  essential  that  their  mental,  moral  and  physical  conditions  be 
kept  constantly  in  view.     Any  tendency  toward  the  forcing  education 
of  the  present  day,  in  which  the  receptive,  emotional  and  intellectual 
parts  of  the  brain  are  overtaxed  or  in  which  the  child  is  allowed  to 
engage  in  competitive  contests,  will  likely  end  in  disaster.     Each  of 
these  brains  is  a  separate  study  unto  itself,  its  capacity  of  receiving  so 
much   edncation  and   no   more,   and   beyond  this   potentiality   no   step 
should  he  taken,   for  it>  will  result  in  exhaustion.     This  applies  with 
equal  force  to  the  motor  areas  of  the  brain  as  well,  and  for  this  reason 
all  over-exertion  in  athletics  should  be  forbidden  and  their  use  cur- 
tailed within  most  reasonable  bounds.     With  the  advent  of  puberty 
in  the  male  great  care  is  to  be  exercised  to  prevent  the  youth  from 
obtaining  false  and  peculiar  ideas  of  himself  or  his  relations  with  the 
opposite  sex.  and  he  should  be  taught  the  truth  concerning  the  func- 
tions   of    reproduction.      He    must    be   particularly   protected    at    this 
time   from  evil  companions,   from  the  use  of  tobacco  and  spirituous 
drinks   of   all   kinds,   seeking  early  hours    for   retirement.      Mawkish 
sentimentalities,    foolish    love    affairs,    eccentricities    and    overweening 
egotism  are  to  be  promptly  checked.     The  girl  should  not  only  receive 
tiie  same  general  restraint  and  teaching,  but  in  addition  be  carefully 
watched   and  treated  at  the  time  of  the  inception  of  the  menstrual 
flow.     It  seems  needless  to  say  that  these  cases  in  either  sex  should 
never  marry,  owing  primarily  to  their  own  condition,  and  secondarily 
to  the  fact  that  they  have  no  right  to  propagate  and  bring  forth  off- 
spring whose  span  of  existence  is  perforce  puny  and  short-lived. 

Dementia  precox,  as  a  rule,  develops  gradually,  the  most  notable 
feature  being  an  incapacity  of  the  child  to  keep  up  with  the  tasks 
allotted.  At  this  time  he  is  apt  to  become  listless  and  irritable,  losing 
interest  in  his  work,  in  his  friends  and  in  his  pleasures  and  enjoy- 
ments. This  may  last  a  number  of  years,  depending  somewhat  upon 
the  age  at  which  the  disease  commences.     Later  he  begins  to  develop 


430  PRACTICAL  HYDROTHERAPY. 

peculiarities,  eccentricities  and  a  notable  weakening  of  the  mental 
faculties,  especially  the  ability  to  concentrate  attention,  to  memorize 
or  remember.  He  may  have  many  symptoms  that  are  generally  diag- 
nosed neurasthenic,  especially  the  head  fullness,  pressure,  insomnia 
and  mental  depression.  Delusional  states  are  apt  to  occur,  especially 
of  persecution,  believing  that  people  are  trying  to  injure,  watch  or 
speak  of  him.  He  lives  in  an  atmosphere  entirely  his  own.  Later 
he  may  become  violent  and  destructive,  or  may  attempt  to  injure 
some  one,  at  which  period  it  becomes  necessary  to  remove  him  from 
home.  Institutions  usually  present  cases  that  wander  aimlessly  about, 
or  sit  all  day  staring  at  some  object,  picking  at  their  clothing,  or  mut- 
tering to  themselves  and  occasionally  breaking  out  in  silly  laughter. 
Cases  usually  present  depreciated  general  health  ;  the  reflexes  are  ex- 
aggerated ;  sleep  usually  upset ;  appetite,  digestion  and  elimination 
poor.  Auto-toxemia  is  present,  arising  from  a  failure  of  the  excretory 
organs.  The  restraint  that  institutional  treatment  imposes  usually 
brings  about  quiet,  followed  by  a  gain  in  flesh.  The  termination  is 
partial  or  complete  dementia,  which  may  last  for  years.  The  pathol- 
ogy of  the  trouble  is  unknown,  but  it  is  believed  to  be  a  congenital 
defect.  The  prognosis  is  unfavorable,  taken  as  a  rule.  A  small  per- 
centage get  well,  others  have  remissions  and  remain  partially  well 
for  years,  but  the  majority  pass  into  a  state  of  dementia  and  remain 
so  until  carried  off  by  some  intercurrent  disease. 

The  treatment  of  dementia  precox  should  start  with  the  child  in 
the  endeavor  to  prevent  the  commencement  of  the  disease,  and  to 
this  end  those  who  have  a  strong  psychopathic  heredity  must  be 
reared  along  the  lines  laid  down  in  another  section,  especial  care  being 
taken  with  their  environment  and  studies.  Should  the  disease  com- 
mence, the  patient  must  at  once  be  removed  to  some  institution  well 
equipped  for  the  treatment  of  these  cases,  where  he  will  be  under  the 
supervising  care  of  some  one  acquainted  with  the  proper  manage- 
ment of  such  cases.  Rest,  fresh  air,  restraint,  over-feeding  and  hydro- 
therapy form  the  best  method  of  treatment.  The  author  has  in  sev- 
eral instances  satisfied  himself  of  the  great  efficacy  of  hydrotherapy 
in  these  cases,  utilizing  full  treatment.  Commence  with  the  electric 
light  bath  or  hot-air  bath  until  perspiration  takes  place,  followed  by 
the  horizontal  or  circular  rain  bath  at  100°  to  104°  F.  for  two  min- 
utes, reduced  to  80°  F.  for  one-fourth  minute,  pressure  twenty-five 
pounds.  Reduce  the  temperature  one  degree  daily  nutil  65°  F.  is 
reached.  A  gain  in  weight  is  always  a  sign  of  improvement  if  the 
treatment  is  started  early.  A  remission  having  taken  place,  the  case 
should  continue  under  the  watchful  care  of  the  physician,  and  on 
the  slightest  evidence  of  recurrence  treatment  is  to  be  repeated,  and 
in  this  way  the  patient  can  frequently  be  saved  many  years  of  use- 
fulness  or   semi-usefulness.     This   method   will  at   all   times   prevent 


MENTAL  DISEASES.  431 

many  of  the  violent  outbreaks  that  occur.     Once  dementia  has  set  in, 
treatment  resolves  itself  simply  into  that  of  custodial  care. 

Paresis. 

General  Paralysis  of  the  Insane;  Dementia  Paralytica;  Paretic 
Dementia;   General  Paresis. 

Paresis  is  a  subacute  or  chronic  cerebral  disease,  degenerative  in 
character,  sometimes  involving  the  spinal  cord,  of  gradual  onset,  char- 
acterized by  the  development  of  tremor,  slurring  speech,  pupillary 
changes,  ataxia  and  trophic  changes,  with  alteration^  in  the  intellec- 
tual and  moral  character,  accompanied  by  unsystemized  ideas  or 
delusions  of  an  expansive  character,  terminating  usually  in  dementia. 

It  is  considered  a  disease  of  modern  civilization,  built  upon  a 
syphilitic  basis.  It  seems  to  be  rapidly  on  the  increase,  and  is  much 
more  commonly  seen  at  the  present  day  in  its  early  stages,  probably 
owing  to  its  being  better  known  and  the  diagnosis  more  frequently 
made.  It  occurs  usually  between  the  ages  of  thirty  and  fifty-five 
years,  more  frequently  in  the  male  than  in  the  female,  and  in  those 
who  are  usually  strong  and  robust.  Kraft-Ebbing  states  that  its  in- 
crease is  m  proportion  to  "syphilization  and  civilization."  This  is 
probably  borne  out  by  the  relation  between  the  sexes  affected — men 
five,  women  one. 

Of  the  predisposing  causes  other  than  those  mentioned,  over-brain 
strain  with  under-brain  power  is  a  powerful  factor — that  is  to  say, 
forced  intellectual  activity  in  those  who  have  imperfect  or  improper 
early  training  and  whose  cortex  is  not  highly  enough  organized. 
The  terrific  strain  incident  to  the  ambitious  pursuit  of  learnmt;  and 
wealth  is  frequently  the  basic  cause.  "General  paresis  is  not  a  penalty 
of  high  cerebral  development,  but  the  expression  of  a  discrepancy — 
an  inadequacy  of  some  brains  to  sustain  the  strain  to  which  the  race, 
as  a  whole,  is  subjected."7  There  is  no  question  but  what  the  ex- 
cessive indulgence  in  alcoholic  beverages  is  a  powerful  influencing 
cause  in  the  development  of  this  disease,  as  it  aids  in  producing  the 
same  character  of  lesions  that  accompany  paresis.  "An  almost  sure 
recipe  for  producing  a  case  of  paresis  is  this :  Let  a  man  of  nervous 
condition  acquire  syphilis,  between  the  ages  of  twenty  and  thirty, 
then  let  him  work  as  hard  as  possible  without  vacation,  under  great 
mental  strain,  drink  a  great  deal  of  alcoholic  drinks  and  indulge  ex- 
cessively sexually.  This  will  be  pretty  sure  to  bring  on  paresis  in 
ten  or  fifteen  years."8  Most  alienists  are  of  the  opinion  that  paresis 
is  changing,  and  that  it  is  becoming  more  a  disease  of  the  brair.  and 
spinal  cord  proper,  father  than  a  mental  disease.     The  disease  usually 

7  Spitzka,   E.    C. :    "Insanity,"    1893.      Paresis,    178. 

8  Dana,    C.    L. :    "Text-Book    of    Nervous    and    Mental    Diseases    and    Psychiatry,"    1904. 
Paresis,   p.   657. 


432  PRACTICAL  HYDROTHERAPY. 

commences  as  an  alteration  in  habits  and  the  ''ethical  sense,  which  lies 
on  most  civilized  human  characters  like  the  bloom  upon  the  peach,  indic- 
ative of  the  highest  culture  and  varying  in  each  individual  with  the 
social  station,  sex,  age,  race  and  nationality."'1  The  character  of  the 
individual  undergoes  a  change,  in  which  spells- of  irritability  or  periods 
of  elation  occur,  accompanied  by  an  egotism  shown  by  the  exalted 
opinion  of  his  own  attainments.  He  may  become  boastful,  forgetful, 
untruthful,  dishonest,  neglecting  his  family  and  business,  making 
foolish  purchases  and  oftentimes  entering  into  propositions  based 
upon  an  idea  of  his  excessive  wealth  and  capacity.  These  conditions 
are  usually  rarely  appreciated  by  the  family,  but  in  a  short  while  the 
symptoms  become  so  marked  as  to  demand  serious  interference. 
Moral  lapses  are  most  frequent  during  this  stage,  the  most  common 
of  which  are  drunkenness,  theft,  assault  upon  individuals,  the  use 
of  profane  and  vulgar  language  in  excess,  and  a  tendency  to  quarrel 
and  assert  himself.  The  physical  symptoms  at  this  time  are  charac- 
teristic— there  is  tremulous  handwriting,  so  marked  at  times  as  to  be 
illegible ;  the  facial  muscles  present  a  distinct  tremor,  especially  if 
they  are  placed  upon  a  stretch,  this  same  tremor  being  present  in  the 
tongue ;  speech  is  thick,  slurring,  and  lapses  occur ;  the  reflexes  are 
exaggerated ;  pupils  irregular,  react  badly  to  light,  or  present  the 
Argyll-Robertson  form.  As  the  disease  progresses  it  may  pass  into 
the  maniacal  stage,  in  which  he  is  excessively  restless,  boastful,  with 
typical  delusions  of  grandeur.  He  is  sleepless,  noisy,  destructive,  vio- 
lent, and  has  various  outbreaks  of  temper.  The  terminal  stage  is 
that  of  dementia,  in  which  the  mind  becomes  more  or  less  of  a  blank. 
The  day,  the  month,  intimate  friends  or  current  events  are  unknown 
to  him.  He  finally  becomes  careless  in  his  person,  must  be  fed  and 
cared  for  as  if  he  were  a  child.  This  stage  is  interrupted  by  apo- 
plectiform attacks,  which  may  be  followed  by  paralysis  or  cause  his 
death.  Exhaustion  finally  closes  the  scene.  The  duration  of  the  dis- 
ease will  average,  when  unchecked,  from  three  to  three  and  one-half 
years,  although  many  cases  remain  alive  for  many  years  after  the 
period  of  dementia — a  living  death. 

The  importance  of  early  diagnosis  cannot  be  overestimated,  and 
for  that  reason  the  general  practitioner,  who  is  the  one  that  mostly 
errs  in  this  direction,  should  always  be  on  the  lookout  for  those 
symptoms  that  would  characterize  this  disease  in  its  early  stages — 
specific  history,  facial  and  tongue  tremor,  disturbance  of  speech, 
exaggerated  or  lost  reflexes,  pupillary  disturbances,  mental  disturb- 
ances of  which  a  change  of  character,  loss  of  memory,  exaggerated 
egotism,  are  the  most  prominent;  changes  in  handwriting,  convulsive 
and  apoplectiform  attacks. 

The   pathology   of   the   disease   is    degenerative    in   character,   the 

9  Gray,  L.  C. :   "Nervous  and  Mental  Diseases,"  1893.     Paresis,  p.  687. 


MENTAL  I)  J  SI:.  IS  BS.  433 

microscopical  appearance  of  which  is  that  of  a  low-grade  inflamma- 
tion, accompanied  by  a  thickening  of  the  membranes  and  arteries, 
with  an  increase  of  perivascular  tissue.  In  this  disease,  as  in  loco- 
motor ataxia,  the  cell  degeneration  precedes  the  increase  of  tissue 
formation,  the  degeneration  being  the  result  of  the  previous  syphilitic 
infection — that  is  to  say,  a  wreckage  left  in  the  wake  of  the  storm. 

"The  prognosis  is  said  to  be  invariably  bad.  If  one  sees  the  pa- 
tient, however,  in  the  carl}-  stage  and  removes  him  at  once  from  all 
forms  of  excitement,  and  makes  him  live  quietly  for  a  year,  using 
anti-luetic  or  tonic  treatment,  one  can  sometimes  check  the  disease, 
at  least  for  a  time.  I  have  several  patients  who  seem  in  this  way 
to  be  apparently  cured.  When  the  disease  has  well  entered  upon  its 
course  it  is  incurable  by  any  means  yet  known.  It  is  probably  true 
that  the  disease  shows  remissions  oftener  than  it  used  to  do,  although 
it  is  less  refractory  to  treatment  than  it  was  formerly."10 

The  treatment  of  paresis,  therefore,  resolves  itself  into  the  treat- 
ment of  the  earlier  stages,  when,  according  to  Dana,  and  in  accord 
with  the  author's  own  experience,  the  patient  can  be  saved.  Four  cases 
of  this  character  in  the  author's  experience  had  led  him  to  seriously 
doubt  the  diagnosis  of  paresis,  although  the  cardinal  symptoms  were 
present,  until  he  had  read  Dana's  experience.  The  diagnosis  made, 
we  should  at  once  commence  the  administration  of  mercury  and  the 
iodides.  The  author  has  a  preference  for  the  hypodermic  adminis- 
tration of  mercury,  the  bichloride  or  salicylate,  rapidly  increasing  the 
doses  until  the  patient  is  brought  plainly  under  its  influence.  In- 
ternally, large  doses  of  the  iodides,  well  diluted,  should  be  given  and 
rapidly  pushed  to  the  highest  possible  point.  In  association  with 
these  medicines,  tonics  and  digestants  should  be  employed.  Feeding 
is  an  important  item,  and  super-alimentation  is  advisable,  supple- 
menting the  usual  meals  by  the  use  of  milk,  cream,  plasmon,  koumyss, 
etc.  The  patient  is  to  be  taken  from  his  occupation,  given  mental  and 
physical  rest,  together  with  moderate  exercise  in  the  open  air,  it 
being  especially  necessary  to  free  him  from  excitement,  worry  and 
care.  It  is  better  for  the  patient  to  leave  his  home  surroundings,  in 
which  annoyance  is  sure  to  be  present.  During  the  time  of  the  initial 
treatment  his  best  interests  are  served  by  treatment  in  some  sana- 
torium, where  his  case  will  be  given  constant  personal  supervision. 
As  soon  as  a  remission  takes  place,  due  to  the  result  of  the  rest,  quiet, 
regular  feeding  and  monotony  of  sanatorium  life,  he  should  be  sent 
to  the  country  and  kept  there  for  a  period  ranging  from  six  to  eight 
months,  thus  spending  about  a  year  in  combating  the  disease.  As 
hydrotherapeutic  measures  have  such  a  powerful  influence  in  com- 
bating the  effects  of  the  toxins  of  syphilis,  this  should  be  instituted 
immediately  in  connection  with  the  internal  medication.  These  cases, 
as  a  rule,  can  be  at  once  placed  in  sanatoria,  where  they  should  receive 

10  Ibidem,  p.   364. 


434  PRACTICAL  HYDROTHERAPY. 

powerful  eliminative  and  tonic  treatment,  the  best  of  which  is  the 
electric  light  bath  or  body  apparatus  of  superheated  dry  hot  air,  be- 
ing allowed  to  remain  within  the  bath  until  profuse  perspiration  takes 
place.  In  the  electric  light  bath  this  generally  requires  from  five  to 
fifteen  minutes;  in  the  superheated  dry  hot-air  treatment  the  patient 
can  profitably  remain  for  one  hour.  Then  give  the  circular  or  hori- 
zontal rain  bath  at  a  temperature  of  100°  F.  for  one  and  one-half 
minutes,  pressure  twenty-five  pounds.  Reduce  temperature  to  70° 
or  60°  F.  for  ten  to  fifteen  seconds.  After  a  few  treatments  of  this 
character  have  established  the  reactive  capacity  of  the  patient,  we 
may  add  to  the  bath  the  cold  jet  under  a  pressure  of  thirty  pounds 
for  ten  to  fifteen  seconds,  applied  up  and  down  the  spine,  taking 
especial  care  to  administer  this  in  the  cervical  region.  The  Turkish 
bath,  for  the  reasons  here  mentioned,  has  gained  some  little  repu- 
tation for  its  action  in  cases  where  active  elimination  of  this  kind  is 
needed,  but  the  author  is  of  the  opinion  that  while  the  bath  may  be 
of  considerable  value,  it  labors  at  a  disadvantage,  owing  to  the  fact 
that  its  application  is  in  the  hands  of  untrained  attendants  who  are 
not  under  the  guidance  of  the  modern  hydriatist.  Associated  pro- 
cedures of  value  are  massage,  galvanism,  vibration  and  the  static 
wave  current. 

When  a  patient  has  once  had  such  a  warning  he  should  so  conduct 
his  life  and  living  as  to  limit  his  work  to  the  essential  necessities  of 
existence,  and  should  twice  a  year  subject  himself  for  periods  ranging 
from  four  to  six  weeks  to  anti-luetic  and  hydrotherapeutic  treat- 
ment. Vacations  should  be  taken  and  alcohol,  tobacco  and  all  ex- 
cesses eschewed. 


CHAPTER  XX. 

DRUG  HABITS. 

Morphine,  Cocaine,  Chloral,  etc.;  Cannabis  Indica;  Hasheesh. 

In  all  countries,  in  all  climates,  in  all  tribes  and  races,  certain  sub- 
stances classified  as  stimulants  and  narcotics  are  used,  and  so  com- 
mon is  the  practice  that  it  may  be  said  to  be  universal.     These  sub- 
stances  are   poisons   producing  more   or   less   profound   physiological 
effects  upon  the  organism,  and  are  usually  taken  to  produce  a  feeling 
of   comfort.      In   small   doses   ideation   and   pseudo-creative    function 
seem  to  be   increased,   and    fancy,   foot- free,  produces   a   joyousness 
and   thoughtlessness,   unhampered   and   undepressed   by   the   wearing 
cares  or  the  warping  canker  of  the  daily  grind   for  existence.     In 
larger  and  fuller  doses  the  narcotic  influence  becomes  more  predomi- 
nant, and  the  correct  relationship  of  the  world  at  large  is  disturbed, 
pleasurable  sensations   engendered  by   retiring  the   individual   into  a 
dreamy  self-centered  world  of  his  own,  the  return  from  which  is  dis- 
turbing and  irritating.     Savage  and  civilized  humanity  both  delight 
in  partaking  of  these  stimulating  and  narcotizing  products,  that  will 
eliminate  pain,  replacing  it  with  pleasure,  and  any  drug  possessing 
the  power  of  Aladdin's  lamp  becomes  a  menace  and  a  clanger  at  all 
times   and  under  all   conditions,    for   I   maintain  this  to  be  true,   no 
matter  how  much  we  may  repeat  the  contrary  and  how  often  we  may 
absolve  our  consciences.     Particularly  should  this  be  borne  in  mind, 
that  pain  is  real,  patent,  positive,  an  imperative  call   for  absolution; 
while  pleasure  is  purely  negative  as  compared  to  pain  and  a  resultant 
of  negative   factors.     Pleasure  depends  so  much  upon  perfection  of 
functional  activity  of  the  body  and  mind,  of  surroundings,  of  temper- 
amental conditions,  as  to  place  solidly  before  us  the  picture  of  com- 
placent good  health,   while  pain  becomes   the  potent  indicator  of   ill 
health  or  disease.     It  has  often  seemed  to  me  that  it  is  the  desire  to 
imitate  the  feelings  of  health  and  strength,  the  well-being  and  happiness 
of  perfect  functionation,  the  bodily  strength  and  mental  activity  that 
compel  many  to  continue  to  use,  and  finally  to  abuse,  alcoholic  drinks 
and  narcotic  drugs.    We  cannot  blame  the  ill,  when  in  many  countries 
the  tired,  the  hungry,  the  thirsty,  the  suffering,  the  depressed,  can,  as 
DeOuincy  said,  "Carry  Paradise  in  the  pocket  for  a  penny."     Painful 
factors  are  unquestionably  at  the  bottom  of  a  great  deal  of  the  use  and 
abuse  of  narcotic  drugs.     Painful  conditions  wear  upon  the  reserve 
(435) 


436  PRACTICAL  HYDROTHERAPY. 

strength,  weaken  mind  and  body,  lessen  muscular  power  and  capacity, 
depress  the  circulation,  producing  gloomy  and  melancholy  mental 
impressions. 

It  should  be  borne  in  mind  that  pleasure  and  pain  are  not  separate 
entities  depending  upon  social  status,  upon  surroundings,  education, 
habits  or  training;  are  not  limited  to  any  social  class  or  financial  con- 
dition, and  it  is  a  noteworthy  fact  that  the  larger  number  of  habitues 
(excepting  possibly  the  Southern  negro)  of  morphine  are  to  be  found 
in  the  middle  and  upper  classes.  Physicians,  the  cultured,  the  literary 
and  artistic  classes,  yield  a  large  percentage  of  cases,  owing  to  an 
over-endowment  of  nerves  or  because  of  neurotic  inheritances.  From 
their  occupation  or  by  tendency  they  are  subject  to  uncomfortable  and 
painful  conditions — notably  insomnia,  neuralgia,  rheumatism  and  pains 
of  all  sorts — and  to  these  the  "hypo,"  with  its  relief,  is  a  dangerous 
spark  that  may  ignite  a  vast  conflagration.  Relief  is  frequently  pur- 
chased, but  it  is  short,  and  the  temporary  surcease  from  pain  and 
sorrow  by  the  use  of  morphine  and  other  drugs  is  nearly  invariably 
followed  by  a  reaction  that  increases  the  misery  and  intensifies  the 
suffering.  There  is  no  more  curious  paradox  than  that  of  drugs,  the 
principal  value  being  that  of  a  pain  reliever,  acting  as  the  direct  cause 
of  pain  perpetuation,  and  it  has  often  seemed  to  me  that  pain  relieved 
and  soothed  by  morphine  and  its  congeners  actually  becomes  worse 
upon  cessation  of  the  drug,  largely  by  contrast,  if  I  may  so  describe 
it,  just  as  black  looks  blacker  on  a  white  background.  It  is  this  over- 
relief  that  constitutes  one  of  the  great  dangers  of  drug  therapy.  The 
cases  in  which  it  is  frequently  administered  are  those  of  functional 
pain,  especially  of  paroxysmal  character,  and  in  which  there  is  an 
apparent  need  for  temporary  and  immediate  relief.  I  have  noticed 
that  painful  states  in  these  people  are  influenced  by  barometric 
changes,  and  that  when  there  is  a  lowered  change  they  are  apt  to 
increase  the  dosage.  Morphine  and  similar  drugs  are  great  obscurers, 
hiding  real  states  of  disease,  both  functional  and  organic,  and  cer- 
tainly obscuring  the  diagnosis  of  the  physician  who  administers  it. 

The  principal  action  of  these  drugs  is  upon  the  nervous  system, 
and  those  who  are  unfortunate  enough  to  be  addicted  to  their  use 
realize  fully  the  inevitable  law  of  action  and  reaction  with  regard  to 
nervous  states.  Upon  ideation  their  action  depends  largely  upon  the 
personal  equation  and  tempermental  peculiarities  of  the  individual. 
Thus  the  dreamer  and  imaginative  person  soars  to  realms  of  fancy, 
peoples  them  with  imaginative  persons,  and  rising  above  the  mean 
level  performs  deeds  of  heroism  and  valor,  or  becomes  a  prince  of 
good  fellows  around  the  festal  board,  or  controls  the  destinies  of 
nations;  others  become  placid  and  dreamy,  and  there  flows  through 
the  mind  pleasurable  facts,  irregular  and  disconnected.  Again,  others 
are    stimulated   to   the   performance   of   tasks,    literary   or   otherwise, 


DRUG  HABITS.  437 

while  still  others  dream  of  far  Oriental  countries  and  strange  dark- 
eyed  houris.  Still  another  type  becomes  talkative  and  an  agreeable 
member  of  every-day  society.  "Here  was  the  secret  of  happiness 
which  the  philosopher  disputed  for  so  many  ages  at  once  discovered. 

Happiness  might  be  purchased  for  a  penny  and  be  carried  in  the 
waist-coat  pocket,  portable  ecstasies."     (DeQuincy). 

Upon  volition  morphine  has  a  marked  effect,  for  few  pi 
sufficient  will-power  and  self-control  while  under  its  domination,  and 
it  were  as  unfair  to  ask  the  unhappy  victim  to  call  into  play  this 
attribute  of  the  mind  and  to  free  himself  of  his  enslaving  thralldom 
as  to  ask  the  typhoid  patient  to  dispense  with  the  febrile  manifesta- 
tions of  the  disease  from  which  he  suffers.  Truthfulness  is  affected; 
I  have  often  weighed  the  question  pro  and  con,  and  have  concluded 
that  the  habitue  is  not  really  quite  as  bad  as  he  is  painted.  There 
is  a  large  percentage  of  these  cases  who  deplore  the  burden  that  they 
carry,  and  who  are  not  degenerates  or  inveterate  liars,  nor  do  they 
deserve  the  reproach  and  condemnation  that  is  often  heaped  upon 
them,  for  frequently  the  habit  has  been  acquired  from  no  fault  of  their 
own.  and  they  are  unable  to  cease  its  use  because  they  are  controlled 
by  forces  beyond  their  capacity  to  resist.  I  should  say  that  all  state- 
ments made  should  be  carefully  weighed,  not  because  of  an  inherent 
desire  to  lie,  but  because,  in  my  opinion,  the  habitue  at  times  lacks  the 
true  qualitative  and  quantitative  appreciation  of  his  surroundings  and 
actions.  As  the  habit  becomes  confirmed  the  excitation  and  pleasur- 
able features  diminish,  and  the  use  of  the  drug  becomes  necessary  in 
order  that  suffering  may  be  abridged,  that  the  daily  tasks  may  be 
performed,  and  at  the  same  time  to  escape  the  misery  that  its  absence 
entails.  Thus  fresh  doses  are  taken  and  a  fresh  lift  given,  another 
fall,  another  lift,  and  so  the  story  goes,  as  did  the  brook,  until  some- 
thing happens  to  change  the  sluggish  stream  and  make  the  unhappy 
victim  yearn  to  break  the  enthralling  chain. 

Curiously  constituted  nervous  systems  exist  on  every  hand,  and 
with  the  increasing  strain  of  modern  life  it  is  not  surprising  that  these 
peculiarly  constituted  organisms  sometimes  acquire  the  morphine  habit 
in  the  twinkling  of  an  eye.  and  I  know  of  a  number  of  cases  in  which 
the  addiction  dates  from  a  single  attack  of  less  than  a  week's  duration. 
These  drugs  are  usually  solitary  indulgences  taken  in  seclusion.  It 
should  be  distinctly  understood  that  in  this  country  the  solitary  use 
of  these  drugs  is  not  purely  to  secure  pleasure.  These  cases  endeavor, 
as  every  reasonable  human  being  would,  to  keep  the  skeleton  in  the 
closet ;  trying  to  present  as  good  a  face  in  public  as  possible.  I  take  it 
that  every  one  is  justified  in  self-protection,  and  it  is  a  notorious  fact 
that  these  people  are  morbidly  sensitive  and  do  not  desire  to  lose  the 
good  will,  respect  and  confidence  of  their  family  and  friends.  Apply- 
ing laws  and  rules  to  this  disorder  that  we  would  to  other  diseased 


438  PRACTICAL  HYDROTHERAPY. 

conditions,  let  me  ask,  would  one  parade  a  specific  or  tuberculous 
affection  to  the  gaze  of  the  world  at  large,  and  would  he  he  considered 
a  pervert,  scoundrel  and  liar  for  not  doing  so?  And  yet  these  people 
act  simply  as  you  or  I  would  act  under  similar  conditions  with  other 
diseases.  There  is  no  question  but  what  the  general  opinion  concerning 
the  use  of  narcotic  drugs  has  been  based  and  framed  upon  that  pro- 
portion of  cases  who  show  absolute  disregard  for  all  the  proprieties 
and  ethics  of  life  and  who  publicly  parade  their  condition.  They  are 
morally  degenerate,  and  would  be  so  regardless  of  their  use  of  drugs. 
I  have  seen  cases  who  have  used  narcotic  drugs,  and  whose  use  of 
them  has  never  been  suspected  by  the  public,  maintain  self-respect, 
business  honor  and  integrity,  and  who  are  highly  regarded  in  the 
community  in  which  they  live.  These  cases  are  those  who  have  had 
moral  and  proper  training  before  the  acquisition  of  the  drug. 

Briefly  passing  to  the  influence  of  these  drugs  upon  the  general 
system,  it  may  be  said  that  their  action  is  functional,  deranging  secre- 
tion, perverting  elimination  and  generally  retaining  poisons  within 
the  body.  They  have  an  especially  pernicious  influence  upon  the 
appetite,  and  by  depriving  the  system  of  food  and  the  heat-generating 
energy  that  arises  from  food,  cause  tissue  loss.  Metabolism  is  less- 
ened and  tissue  waste  retained,  and  with  the  absence  of  proper  nutri- 
ment in  the  blood  stream  failure  of  repair  takes  place,  for  in  the 
absence  of  sufficient  nutriment  the  body  feeds  on  its  own  tissues  and 
loss  of  weight  is  a  consequence.  By  diminishing  irritation  they  some- 
what lessen  wear  and  tear,  but  at  a  cost  not  to  be  considered. 

Physicians  form  quite  a  large  class  of  drug  users,  strange  as  it 
may  seem,  when  they  know  fully  the  dangers,  both  to  themselves  as 
patient  and  as  medical  advisers  to  others.  The  life  of  a  physician  is 
a  hard  one,  and  a  large  percentage  are  either  neurasthenic  or  neuras- 
thenoid  one-half  of  the  time.  The  incessant  demands  day  and  night, 
the  loss  of  sleep,  the  physical  strain,  the  mental  worry,  are  so  ha- 
rassing and  burdensome  that  after  the  wear,  tear  and  exposure  inci- 
dental to  their  lives  acute  mental  and  physical  tire  is  produced.  Then 
comes  a  tiny  dose  to  "tide  me  over."  A  false  and  frantic  endeavor 
to  escape  by  this  means  Nature's  inexorable  law  leads  to  the  formation 
of  the  habit.  In  a  large  experience  with  doctors  I  think  I  can  truly 
say  that  they  can  stand  less  pain  and  suffering  than  almost  any  other 
class.  A  drug  habit  is  an  imperious  mistress  that  cannot  be  easily 
shaken  off,  for  by  slow  degrees  and  insidious  steps  she  becomes  the 
dominant  influence  of  the  being's  existence.  It  creates  an  appetite 
for  itself  with  a  yearning  and  desire  on  the  part  of  the  nervous  system 
for  repetition.  It  is  astonishing  to  what  extent,  by  gradual  training, 
the  system  can  become  habituated  to  the  large  doses  some  patients 
use.     It  almost  baffles  belief  at  first  sight. 

From  a  careful  study  of  case-records  the  author  is  constrained 


DRUG  HABITS.  439 

to  believe  that  the  most  prominent  starting-point  of  the  habit  has 
been  the  medical  use  or  the  medical  prescription.  I  cannot,  in 
measured  terms,  condemn  too  hashly  the  medical  member  who  con- 
sents to  or  places  the  hypodermic  syringe  in  the  hands  of  the  patient, 
and  as  the  commonest  demands  for  its  use  are  pain  and  insomnia,  I 
again  say  that  it  is  a  fatal  carelessness  that  would  permit  its  use,  save 
to  open  the  fields  of  euthansia  in  hopeless  disease.  Where  is  the 
vaunted  responsibility,  the  higher  ethics,  the  plain  home-made  honesty? 
Have  they  become  drugged  and  anesthetized  under  a  case-hardened 
conscience  ? 

There  are  two  great  classes  in  which,  for  convenience  only,  I  would 
divide  those  addicted  to  the  use  of  narcotics : 

1.  Those  who  have  become  habitual  users  through  pain,  suffering, 
etc.,  and  have  acquired  the  habit  through  medical  use  or  necessity. 

2.  Those  who  use  them  purely  as  a  means  of  gratification  or 
dissipation. 

This  division,  clinical  in  character,  has  much  to  do  with  the  treat- 
ment and  prognosis.  In  the  first  class — and  I  am  happy  to  say  that 
they  form  the  larger  body — we  find  those  who  have  acquired  the  use 
of  drugs  through  the  actual  prescribing,  advice  or  sanction  of  the 
physician  himself.  Many  patients  suffering  from  this  affection  tell 
of  the  hypodermic  as  a  starting-point  for  the  temporary  relief  of 
rheumatism,  neuralgia,  neuritis,  headaches,  insomnia,  and  many  others 
in  which  the  use  of  such  methods  were  needless,  valueless  and  danger- 
ous. It  is  to  be  regretted  that  its  use  is  often  substituted  for  a  real 
diagnosis  of  conditions  and  as  a  therapeutic  means  requiring  no  great 
understanding  of  the  pathology  of  the  case.  Into  this  class  most  of 
the  physicians  fall,  and  I  am  constrained  to  believe,  from  a  somewhat 
extensive  experience  and  confidential  knowledge,  that  physicians  form 
about  one-fourth  of  the  narcotic  drug-users.  Can  it  be  that  a  physi- 
cian who  uses  morphine,  drugs  or  alcohol  learns  easily  to  rely  upon 
them,  and  upon  the  slightest  provocation  takes  them  himself? 

The  second  class  is  formed  by  those  who  love  the  stimulant  and 
narcotic  per  se,  who  do  not  desire  to  quit,  who  seem  to  fail  to  recognize 
all  that  their  condition  means,  in  whom  the  desire  does  not  exist  to 
escape  thralldom,  but  seem  to  revel  in  the  pleasure  and  joy  the  drug 
gives  and  long  to  continue  its  use.  Pride,  conscience,  the  higher 
mental  and  moral  attitudes,  seem  to  be  lost,  and,  reveling  in  a  dissi- 
pation that  nothing  will  stop,  they  drift  slowly  down  stream  to  the 
bosom  of  the  great  ocean  of  the  "other  half,"  to  be  later  cast  upon 
the  shore,  the  flotsam  and  jetsam  of  a  lost  life.  These  are  the  cases 
that  are  brought  to  us  by  parents  and  friends  who  desire  to  escape 
the  degradation  that  has  been  forced  upon  the  family. 

Occupation  and  mode  of  life  have  a  good  deal  to  do  with  how 
drug  addictions  are  borne,  and  influence  markedlv  their  effects.     The 


440  PRACTICAL  HYDROTHERAPY. 

worst  results  are  seen  in  those  who  lead  sedentary  lives  and  take  little 
fresh-air  exercise,  and  for  this  reason  and  others  the  worst  cases  are 
seen  in  women  and  those  confined  indoors.  The  laborer,  using  his 
muscles  in  the  open  air  all  day,  can  consume  more  alcohol  and  take 
more  morphia  with  less  deleterious  effects  than  the  same  individual 
under  close  housing  conditions. 

Where  opium  and  its  congeners  are  taken  per  oram — that  is  to  say, 
"eaten" — it  is  much  slower  in  its  effect.  My  observations  lead  me 
to  believe  that  the  hypodermic  administration  leads  to  a  more  speedy 
and  permanent  addiction.  I  have  never  been  able  to  distinguish  much 
difference  between  the  fluid  and  the  solid  preparations  of  the  drug, 
they  being  about  the  same  in  their  action.  The  main  difference  in  this 
method  is  the  gastro-intestinal  disturbances.  Opium  when  smoked 
is  quickly  absorbed,  and  is  less  injurious  because  only  limited  quanti- 
ties can  be  inhaled  in  a  given  time.  This  method  is  the  far  Eastern 
one,  and  is  not  generally  used  except  in  the  larger  cities  in  the  country. 

The  "popularity"  (  ?)  of  morphinism  and  cocainism  has  largely 
been  due  to  the  rapidity  and  certainty  of  the  results  obtained  from 
their  subcutaneous  use.  That  modern  blessing  and  pest,  the  hypo- 
dermic syringe,  enables  the  user  to  carry  in  a  small  space  all  his 
needed  impedimenta.  It  is  interesting  to  observe  the  rapidity,  accuracy 
and  dexterity  obtained  by  the  users  of  the  drug  in  hypodermic  admin- 
istration. The  favorite  seats  of  administration  in  men  are  the  arms, 
and  for  obvious  reasons  the  legs  in  females.  Many  utilize  the  ex- 
tremities during  the  day  and  the  trunk  at  night.  While  narcotic  drugs 
are  still  taken  by  the  mouth  by  quite  a  large  number  of  habitues,  still 
the  hypodermic  is  the  commonest  method  now  practiced.  That  the 
consumption  of  morphine,  cocaine  and  allied  drugs  is  annually  enor- 
mously on  the  increase  is  attested  by  the  stupendous  increased  con- 
sumption of  these  drugs,  and  this  is  not  due  to  legitimate  medical 
usage,  but  is  unquestionably  so  through  the  purchase  by  laymen  and 
those  addicted  to  their  use.  It  may  be  that  the  calm  temperamentality 
possessed  by  the  Eastern  and  Indian  peoples  may  account  for  the 
moderation  found  in  the  use  of  opium  in  those  countries,  but  the 
Anglo-Saxon  seems  peculiarly  prone  to  its  excessive  use.  This  abuse, 
if  we  are  to  believe  the  authorities  of  various  countries,  is  greater  in 
America  than  in  England.  A  ready  explanation  may  be  found  in  the 
difference  in  climatic  conditions  and  in  the  strenuous  struggle  that 
marks  the  lives  and  existence  of  different  nations.  In  the  Eastern 
peoples  hereditary  attenuation  may  possibly  be  a  predisposing  factor 
in  preventing  excessive  intoxication. 

No  pathological  anatomy  of  a  distinct  character  has  been  found  in 
this  disorder,  all  observations  pointing  to  a  tissue  starvation,  inan- 
ition, and  lack  of  nutritive  processes.  This  is  really  the  general  ap- 
pearance  in   health,   and   we   may   state   that   "drugism"   presents   no 


DRUG  HABITS.  441 

distinctive  pathological  anatomy,  l>ut  its  action  deals  with  function 
only.  This  is  an  important  matter  to  bear  in  mind,  as  it  influences 
largely  the  question  of  prognosis  and  restoration.  What,  then,  is 
the  essential  pathology  of  the  conditions?  In  my  opinion,  it  is  a  tox- 
emia presenting  two  distincl  phases  of  poison,  each  closely  corre- 
lated to  the  other.  The  first  is  an  endogenous,  internal  or  auto- 
infective  process  arising  from  the  waste  products  in  the  system  due 
to  imperfect,  defective  and  inadequate  action  of  the  excretory  or- 
gans of  the  bowels,  kidney  and  skin  ;  to  lessened  and  weakened  circu- 
lation, improper  metabolism  and  defective  nerve  function.  The  second, 
an  exogenous,  external  or  foreign  poison  (morphine,  cocaine,  etc.) 
introduced  by  mouth  or  hypodermically,  daily  or  at  short  intervals, 
producing  its  own  peculiar  intrinsic  action  upon  the  skin,  bowel, 
kidney,  circulation,  tissue  change,  brain  and  nerves,  and  enhancing 
the  poison  mentioned  in  the  first  class. 

When  we  stop  and  reflect  that  in  the  process  of  digestion  of  food- 
-tiif's  toxic  material  is  produced,  and  that  there  arises  a  necessity 
for  healthy  glandular  action  to  counteract  them,  and  by  which  poisons 
are  nullified,  it  must  become  apparent  that  if  this  be  true  of  health, 
what  must  be  the  condition  of  affairs  when  there  is  superadded 
poisons  which  lock  up  the  natural  secretions  of  the  stomach  and  in- 
testines and  prevent  the  elimination  of  the  toxic  product  already  pres- 
ent? This  is  particularly  true  of  those  poisons  that  come  from  al- 
buminous foods  (meats),  whose  tendency  towards  the  production 
of  toxins  and  katabolic  waste  material  is  well  known.  In  my  own 
mind  I  feel  satisfied  that  with  this  condition  as  a  working  basis  we 
can  remove  many  of  the  most  disagreeable  and  dangerous  symptoms, 
such  as  shock,  heart  failure,  diarrhea,  collapse,  etc.,  by  the  removal 
of  the  toxic  condition  prior  to  the  entire  withdrawal  of  the  drug 
itself. 

In  this  connection  I  may  state  very  frankly  that  I  do  not  blame 
habitues  for  attempting  to  secure  the  drug,  for  my  observation  is 
that  most  of  them  believe  that  death  or  insanity  will  be  their  lot 
unless  proper  help  is  obtained.  This,  in  many  instances,  is  based 
upon  a  personal  experience  of  attempted  withdrawal  of  the  drug  by 
the  patient  himself  or  by  well-meaning  friends  and  relatives.  When 
the  drug  is  quickly  reduced  or  entirely  removed  without  sustaining 
and  appropriate  treatment  we  may  expect  the  sufferer  in  a  few  hours 
to  complain  of  a  general  and  gradually  increasing  weakness,  accom- 
panied by  excessive  nervousness  and  restlessness ;  in  a  short  time, 
great  distress,  accompanied  by  weak  and  constricted  feelings  about 
the  heart  and  chest,  the  latter  frequently  attended  by  a  cough.  A 
gradual  increase  of  all  these  symptoms,  together  with  persistent  in- 
somnia and  many  hallucinations  and  muscular  twitchings,  ensues.  A 
constant    and    disagreeable    yawning    and    sneezing,    together    with    a 


442  PRACTICAL  HYDROTHERAPY. 

drawling  voice,  are  usually  found.  The  prostration  usually  reaches 
such  a  point  that  the  patient  takes  to  his  bed  and  complains  of  rack- 
ing pains  in  the  back  and  limbs,  especially  in  the  calves ;  many  state 
that  the  muscles  feel  as  though  being  torn  from  their  sockets.  The 
appetite  is  lost  and  the  stomach  becomes  excessively  irritable,  nausea 
most  disagreeable  and  persistent,  to  which  latter  is  added  a  weak- 
ening and  prostrating  diarrhea.  The  heart's  action  is  weak  and  ir- 
regular, and  may  intermit ;  the  pulse  small  and  thready.  With 
this  brief  resume  of  the  disagreeable  symptoms  that  attend  the  im- 
proper withdrawal  of  the  drug,  the  habitue  cannot  be  blamed  for 
objecting  to  its  withdrawal  or  endeavoring  to  secure  the  drug  that 
will  alleviate  his  suffering.  With  the  proper  withdrawal  these  symp- 
toms do  not  occur,,  or,  if  they  do,  should  be  very  mild  and  transient 
in  character. 

Treatment  is  not  easy,  but  those  cases  that  belong  to  the  first  di- 
vision of  the  clinical  classification  above  mentioned  may  expect  com- 
plete relief  and  cure  with  comparatively  no  suffering.  A  frank, 
open  talk,  making  the  patient  fully  acquainted  with  the  manner  and 
method  of  relief,  has  much  to  do  to  secure  confidence  and  imbue 
hope,  and  this  feature  of  the  case  is  an  essential  and  necessary  one. 
Has  it  ever  occurred  to  you  that  these  people  have  been  the  outcasts 
of  medicine,  without  hope,  spurned  and  derided  as  lacking  in  all  the 
higher  mental  and  moral  traits?  To  give  them  hope  is  to  give  them 
courage,  and  I  say  candidly  and  advisedly  to  not  recognize  them  as 
diseased  is  to  reflect  upon  the  intelligence  and  capacity  of  those  who 
make  the  statement.  Let  us  give  them  hope,  the  greatest  of  all  stim- 
ulants, and  a  gift  that  the  Deity  has  offered  unto  all  mankind.  Be 
not  uncharitable  to  their  faults  and  sufferings,  deal  kindly,  thought- 
fully and  patiently  with  them,  and  you  will  become  their  anchor  of 
hope.  Rob  them  of  this  and  their  strength  and  vigor  are  gone ;  with 
it  they  fight  the  battle  better  and  more  gloriously.  It  has  always 
seemed  to  me  that  one  of  the  essential  features  of  the  treatment  of 
this  class  of  cases  is  the  physician  himself.  He  should  not  only  be 
healthy — mens  sana  in  corpora  sano — but  should  be  a  non-user  of 
all  drugs,  should  not  use  alcohol,  and  should  preferably  be  an  ab- 
stainer from  the  use  of  tobacco.  This  is  a  personal  part  of  the  equa- 
tion that  a  physician  who  treats  these  unfortunates  should  keep  in 
mind. 

There  is  a  powerful  and  stimulating  psychic  factor  in  the  presen- 
tation of  the  problem,  "Do  as  I  do,"  to  say  nothing  of  the  large  ele- 
ment of  voluntary  submission  that  inevitably  falls  from  a  contempla- 
tion of  this  factor.  Xo  man  can  truly  occupy  a  judicial  position  who 
is  a  law-breaker,  and  no  physician  is  qualified  in  this  particular  line 
of  work  who  is  a  drug-taker.  Under  this  term  I  include  the  use  of 
liquor. 


DRUG  i  1.1  HITS.  443 

Having  thoroughly  understood  each  other,  and  with  confidence  in 
each  other,  what,  then,  are  the  necessary  steps  to  the  management  of 
these   people?      1    would   divide   the   treatment    into   three   stages: 

1.  Preliminary  or  preparatory  stage. 

2.  The    withdrawal    of   the   drug   itself. 

3.  Convalescent  or  recuperative  period. 

A  most  careful  preliminary  examination  must  be  made  of  each 
and  every  one  of  these  cases.  Elimination  can  be  heightened  by  the 
drinking  of  large  quantities  of  pure  water.  I  know  of  no  mineral 
water  that  is  of  value  in  these  cases.  If  laxative  medicines  are 
needed  I  generally  confine  myself  to  the  well-established  action  of 
cascara  sagrada  at  bedtime.  These  cases  can  only  be  treated  in  sana- 
toria. 

\\  e  may  at  once,  in  the  majority  of  cases,  commence  with  the 
electric  light  bath  or  superheated  dry  hot  air,  continuing  this  for  the 
first  few  days  until  the  patient  just  perspires,  thereafter  using  it  until 
profuse  perspiration  takes  place.  This  may  be  followed  by  the  hori- 
zontal or  circular  rain  bath  at  a  temperature  of  102°  to  104° F.  for 
two  minutes,  reduced  to  85°  for  one-quarter  minute,  pressure  twenty 
pounds.  Decrease  the  temperature  of  the  cold  water  three  degrees 
daily  to  65°  F.  and  increase  the  pressure  one  pound  until  thirty  is 
registered.  It  is  often  astonishing  how  these  patients  clear  up  under 
this  treatment.  Hyperesthetic  impressions  traveling  from  the  periph- 
ery to  the  center  are  lessened,  nerve  tone  improved,  circulation  bet- 
tered, elimination  hastened,  appetite  improved,  respiration  increased, 
and  the  dry  and  harsh  skin  made  to  become  succulent  and  eliminative 
in  action.  It  is  by  this  means  that  the  internal  toxemia  is  rapidly 
and  satisfactorily  removed.  Note  should  be  taken  that  for  the  first 
few  days  no  attempt  is  made  to  reduce  the  quantity  of  the  drug  taken. 
but  reduction  is  reserved  until  the  patient's  reactive  and  recuperative 
entities  have  been  stimulated. 

In  some  cases  it  is  advisable,  before  taking  the  next  step  in  the 
treatment,  if  possible,  to  add  to  the  above  treatment  a  very  brief  appli- 
cation of  the  spray  douche  to  the  entire  body  for  five  to  ten  seconds, 
and  the  jet  douche  for  five  seconds  to  the  spinal  column,  both  at  a 
temperature  of  65°  F.  In  no  class  of  cases  is  it  more  necessary  to 
secure  reaction  than  in  these  habitues.  The  drug  is  gradually  reduced 
until  practically  none  is  taken,  at  which  the  patient  is  put  to  bed  and 
kept  there.  A  special  nurse  is  placed  with  him  and  remains  with  him 
night  and  day.  The  treatment  of  this  stage  is  largely  that  of  the  Weir 
Mitchell  rest  cure,  which  has  been  elaborated  in  another  section.  In 
the  application  of  this  method  of  treatment  the  diet  should  be  liquid, 
supportive,  and  from  which  all  meats  have  been  eliminated.  Tonics 
are  continued,  and  neuro-cardio-vascular  support  given  by  hypodermic 
administration  of  well-known  remedies  of  this  class.     The  schedule 


444  PRACTICAL  HYDROTHERAPY. 

starts  with  the  dripping  sheet  in  the  morning  before  breakfast.  As 
the  patient's  reactive  power  has  become  well  established,  we  may  at 
once  commence  with  a  wet  sheet  at  a  temperature  of  60°  F.  for  three 
minutes,  accompanied  by  vigorous  friction  while  the  patient  stands 
in  a  foot-tub  of  as  hot  water  as  can  be  comfortably  borne.  During 
the  day  massage  and  electricity  are  used.  At  night,  one  hour  before 
bedtime,  the  full  wet  pack  at  a  temperature  of  60  F.  is  used,  which 
will  have  a  decided  tonic,  quieting  and  soporific  effect.  If  it  is  ac- 
cessible, we  may  employ  the  neutral  bath  at  96°  to  94°  F.  for  twenty 
to  forty  minutes,  and  this  bath  will  be  found  of  unusual  help  and 
comfort.  Should  the  patient  at  this  stage  complain  of  localized  cramps 
or  pains  in  the  muscles,  especially  in  the  calf,  we  may  apply  the  fo- 
mentation over  the  area  affected ;  it  will  give  almost  immediate  relief. 
Should  insomnia  accompany  the  condition,  nothing  need  be  given  save 
the  wet  pack  or  the  neutral  bath.  For  the  nervousness,  restlessness 
and  "indescribable  sensations,"  the  author  has  found  nothing  that 
compares  with  the  neutral  bath,  and  if  this  is  not  accessible  the  next 
thing  to  be  used  is  the  dripping  sheet  or  the  full  wet  pack.  Cardiac 
weakness  is  best  met  by  means  of  the  ice-bag  applied  over  the  pre- 
cordial region  for  fifteen  to  twenty  minutes.  Should  this  condition 
continue,  its  application  may  be  interrupted  for  a  very  brief  appli- 
cation of  a  hot  compress,  to  be  in  its  turn  succeeded  by  the  ice-bag. 
For  the  pain  occurring  in  the  spine  and  lumbar  muscles  the  alternate 
hot  and  cold  sponge  will  give  almost  instant  relief.  Vomiting  should 
be  met  by  lavage,  the  swallowing  of  small  pieces  of  ice,  and  the  trunk 
compress  at  a  temperature  of  65°  F.  for  one  to  two  hours,  or  the  use 
of  Neptune's  girdle  during  the  night.  In  like  manner  diarrhea  is  to 
be  overcome  by  the  hot  saline  enema,  followed  by  the  trunk  compress 
or  pack.  It  may  be  stated,  however,  that  where  the  preliminary 
treatment  has  been  thorough  few  of  these  symptoms  will  arise. 

It  should  be  noted  in  passing  that  at  this  stage  of  the  game  we 
have  our  patient  in  the  most  favorable  surroundings.  With  prac- 
tically no  discomfort,  with  the  moral  help  and  support  that  a  nurse 
and  physician  can  give,  he  knows  that  it  is  only  for  a  comparatively 
few  hours  that  a  strain  must  be  undergone.  The  continued  sedation 
and  neural  strengthening  that  come  from  the  administration  of  the 
non-medicinal  remedies  make  his  condition  at  this  period  a  very  pleas- 
ant one  as  compared  with  the  horrors  generally  depicted  or  believed 
to  exist;  and,  in  addition,  we  do  not  have  to  deal  with  the  delirium 
that  accompanies  the  administration  of  hyoscine.  The  duration  of 
this  stage  is  usually  short,  and  with  the  complete  withdrawal  of  the 
drug  it  is  astonishing  how  quickly  appetite  returns,  digestion  im- 
proves and  the  cloaca  regulate  themselves. 

The  third  or  convalescent  stage  embraces  a  period  that  is  difficult 
to  estimate,  but,  in  my  opinion,  should  never  be  less  than  four  weeks, 


DRUG  HABITS.  445 

preferably  six.  The  convalescent  period  is  largely  a  resumption  of 
the  preparatory  stage — that  is  to  say,  the  use  of  tonics  and  the  admin- 
istration of  the  various  non-medicinal  measures  with  a  view  to  the 

stimulating  of  the  functions  of  the  body  and  removing  them  from 
the  warped  habit  of  action  that  has,  as  a  rule,  constituted  their  con- 
dition. During  this  stage  hydrotherapy  should  be  vigorously  pushed, 
and  the  treatment  recommended  in  the  first  or  preliminary  stage, 
consisting  of  the  electric  light  bath  to  perspiration,  the  circular  or 
horizontal  rain  bath,  fan  and  jet  douche  administered  every  day,  vig- 
orous reaction  being  secured. 

Before  the  patient  is  dismissed  all  medicinal  treatment  is  -topped, 
and  he  is  impressed  with  the  idea  that  he  does  not  need  drug-  of  any 
kind  or  sort,  and  that  for  him  the  resumption  of  medicinal  measures 
is  dangerous  because  of  their  subtle  suggestiveness  and  because  of 
the  previous  association  of  morphine  with  the  idea  of  drug  taking. 

Upon  their  dismissal  patients  must  keep  in  close  touch  with  the 
physician,  either  by  correspondence  or  personal  interview,  and  I  think 
that  where  this  is  maintained  for  quite  a  little  while  the  "cure"  is, 
as  a  rule,  better  and  more  satisfactory. 

It  is  my  universal  practice  to  suggest  to  these  cases  that  they 
continue  tonic  hydrotherapy  in  their  homes  upon  the  resumption  of 
the  duties  of  life.  I  am  satisfied  that  if  these  cases  practice  the  daily 
use  of  the  cold  sponge  or  the  cold  shower  bath,  it  will  be  found  that 
they  are  less  likely  to  relapse,  for  it  is  a  fact  beyond  question  or  perad- 
venture  that  the  vasomotor  system  must  be  kept  in  tone  for  months 
in  order  that  no  relapse  occur,  and  that  where  this  is  done  they 
generally  retain  good  health  and  no  cause  arises  for  a  relapse.  The 
same  advice  may  be  given  that  should  be  given  every  individual  in 
health  or  out  of  health,  and  that  is  that  tonic  hydrotherapy  is  indicated 
and  needed  as  a  part  and  parcel  of  their  daily  existence. 

I  think  that  the  majority  of  thoughtful  men  will  agree  with  me 
when  I  say  that  personality  has  a  great  deal  to  do  with  the  successful 
management  of  these  cases,  probably  as  much  as  in  the  management 
of  the  hysteric.  Judgment,  tact,  patience,  thoughtfulness,  attention, 
faithfulness  and  kindess  are  great  levers  by  means  of  which  we  can 
attain  the  end. 

Tobacco  Habit. 

Tobacco  consists  of  the  dry  leaves  of  the  Nicotina  Tabacum  Lin- 
naeus, one  of  the  order  of  Solanaccae.  It  is  a  rank,  viscid,  hairy 
plant,  two  to  four  feet  in  height,  with  coarse  alternate  leaves,  having 
a  disagreeable  odor  and  taste,  and  turning  brown  on  drying.  It  is 
indigenous  to  America,  but  is  now  grown  over  the  entire  world.  The 
seeds  are  first  sown  in  beds  in  the  early  spring  and  are  then  trans- 
planted, and  after  growth  the  flowering  tops  are  cut  off  so  as  to  en- 


446  PRACTICAL  HYDROTHERAPY. 

courage  the  spread  of  the  remaining  leaves.  In  August  or  September 
the  leaves  are  gathered,  dried  under  cover,  then  piled  up  and  allowed 
to   ferment   or   "sweat." 

Tobacco  is  familiar  to  every  one  and  needs  no  special  descrip- 
tion, its  only  important  active  principle  being  nicotine,  which  is  pres- 
ent to  the  extent  of  from  1  to  8  per  cent.,  in  combination  with  citric 
and  malic  acids.  Opposed  to  the  popular  idea,  nicotine  is  a  volatile 
oily  fluid,  soluble  in  water,  and  when  fresh  nearly  odorless,  colorless 
and  tasteless.  Its  chemical  structure  is  not  known  with  definiteness, 
but  is  supposed  to  be  C1ClH14X2.  Besides  nicotine,  dry  tobacco  con- 
tains pyridine,  other  decomposition  products,  and  an  oil  which  is  of 
importance,  as  it  determines  the  flavor. 

Tobacco  has  been  investigated  chemically  and  physiologically  re- 
peatedly, and  the  more  recent  results  of  such  work  have  shown  that 
its  deleterious  effects  are  not  due  entirely  to  nicotine,  but  to  the  de- 
composition products,  more  often  pyridine.  This  is  the  black  oily 
juice  which  collects  in  the  stems  of  foul  pipes,  is  often  taken  in  when 
the  pipe  is  again  smoked,  and  is  shown  to  be  extremely  poisonous. 
The  cigar  smoker  has  the  nicotine  and  pryidine  partly  evaporated 
and  partly  broken  up  in  the  burning  end  of  the  cigar,  to  be  recon- 
densed  and  deposited  in  the  stub  end  of  the  cigar  which  is  thrown 
away.  Of  the  various  methods  of  use,  the  pipe  is  the  most  deleteri- 
ous; the  cigar  next,  and,  contrary  to  the  opinion  held  by  the  average 
layman,  though  true,  the  cigarette  used  in  moderation  is  unquestion- 
ably the  least  harmful  method  of  smoking.  Cigarettes  are  so  mild 
that  the  smoker  is  tempted  to  use  a  large  number  of  them,  and  by  this 
means  constantly  though  slowly  absorbs  a  great  deal  of  poison.  An- 
other objection  is  the  inhalation  of  the  smoke.  Their  mildness  leads 
young  persons  and  women  to  use  tobacco.  The  popular  belief  that 
cigarettes  contain  opium,  and  the  rice  paper  deleterious  substances, 
has  little  or  no  foundation  in  fact,  when  viewed  either  from  a  com- 
mercial or  chemical  standpoint. 

What  constitutes  excess  is  a  variable  quantity.  There  are  some 
individuals  to  whom  the  smallest  amount  of  tobacco  is  excessive  and 
seems  to  possess  an  injurious  effect. upon  their  systems.  There  are 
others  who  are  able,  with  enjoyment  and  apparent  immunity  from 
evil  effects,  to  smoke,  chew  or  snuff  tobacco,  seemingly  to  live  lives 
of  length  and  healthful  activity ;  these  cases  frequently  consume  to- 
bacco during  their  entire  waking  hours.  There  seems  to  be  no  means 
of  detecting  the  liability  of  tobacco  intolerance,  and  some  persons 
who  are  apparently  possessed  of  very  strong  nervous  systems  seem 
highly  sensitive  to  tobacco,  my  own  observations  being  that  high- 
strung,  neurotic  men,  young  people  and  women  are  more  easily  af- 
fected by  its  use.  Be  this  as  it  may,  the  broad  fact  remains  positively 
true  that  it  is  a  potent  poison,  the  effects  of  which  tend  to  debilitate 


DRUG  11. 1  HITS.  447 

the  system,  stunt  the  growth,  and  deprave  the  functions,  and  it  goes 
without  saying  that  a  general  abstinence  from  its  use,  especially  by  the 
young,  would  undeniably  promote  the  health  and  strength  of  the 
population. 

Every  smoker  is  a  law  unto  himself,  and  the  quantity  that  can 
be  smoked  by  one  man  may  be  poisonous  to  another,  and  for  this  rea- 
son each  smoker  has  to  estimate  his  own  capacity  and  regulate  the 
quantity  smoked  thereby.  It  is  an  astonishing  fact  that  in  spite  of 
the  deadly  pallor,  cold  sweat,  horrible  nausea,  vomiting  and  collapse 
which  follows  the  first  use  of  tobacco,  that  man,  the  highest  animal 
in  the  scale  of  intelligence,  will  continue  its  use  until  tolerance  is  es- 
tablished. It  is  among  the  psychological  curiosities  that  man  would 
be  willing  to  discipline  himself  in  such  an  habituation.  It  is  to  be 
regretted  that  the  use  of  tobacco,  especially  cigarette  smoking,  among 
girls  and  women  in  the  middle  and  cultured  cla-^e-.  with  its  deletri- 
ous  influence  upon  their  more  sensitive  nervous  systems,  is  constantly 
spreading. 

It  is  interesting  in  the  study  of  the  tobacco  habit  to  note  the  two 
extreme  camps  into  which  the  parties  divide  themselves.  On  the  one 
hand  the  "divine  weed"  has  been  denounced  as  the  Satanic  embodi- 
ment of  all  that  is  physically  mischievous  and  morally  deadening, 
while,  on  the  other  hand,  it  has  been  claimed  to  be  an  innocent,  harm- 
less, pleasing  and  comforting  weed,  which  adds  to  the  pleasure  of 
many,  injuring  the  health  of  none,  and  bringing  blessings  into  the  life 
of  the  "hard-working  man."  The  truth  probably  lies  between  the  two 
extremes ;  though  not  an  innocent  substance,  it  is  a  weed  that  permits 
some  persons  to  smoke  or  otherwise  use  it  without  apparent  disagree- 
able effects,  distress  or  danger.  Even  the  most  habitual  smoker  may 
become  a  subject  of  tobacco  poisoning  when  his  health  is  run  down. 

The  popular  belief  that  cigarettes  are  the  cause  of  many  cases  of 
insanity  is  exploded  upon  investigation.  Babcock,  in  his  report  to  the 
Massachusetts  State  Commission  of  Public  Health,  found  upon  in- 
vestigating cigarettes  purchased  in  the  open  market  that  the  speci- 
mens contained  no  opium,  morphine,  or  other  drug  or  poison,  but  were 
found  to  consist  of  tobacco,  nothing  else;  the  papers  were  of  excellent 
quality  and  free  from  metallic  and  other  poisons.  It  is,  in  fact,  a  tiny 
cigar  wrapped  in  paper  for  a  few  whiffs  or  a  brief  smoke. 

Acute  tobacco  poisoning  occurs  most  frequently  in  inexperienced 
and  young  smokers  who  have  not  thoroughly  established  tolerance  of 
the  poisonous  effects  of  the  weed,  although  the  writer  knows  of  sev- 
eral cases  in  which  acute  poisoning  has  arisen  from  breathing  air 
laden  wTith  tobacco  smoke.  Severe  cases  of  acute  poisoning  are  ex- 
tremely rare  in  spite  of  the  extensive  use  of  this  luxury  in  its  various 
forms.  The  symptoms  of  mild  poisoning  usually  commence  with  a 
peculiar  sinking  feeling  at  the  pit  of  the  stomach,  with  clammy,  coldish 


448  PRACTICAL  HYDROTHERAPY. 

perspiration,  vertigo,  tremor,  increased  salivation,  vomiting  and  pros- 
tration. Severer  symptoms  are  generally  cut  short  because  the  smoker 
is  deterred  from  further  use  of  the  agent  or  on  account  of  the  nausea 
and  weakness.  Where  larger  quantities  are  introduced  the  poisoning 
may  pass  to  the  stage  of  extreme  prostration,  abdominal  pain,  etc. 
The  pupils  are  generally  contracted,  and  in  the  later  stages  dilate. 
The  pulse  is  nearly  always  rapid,  small  and  weak.  Some  writers 
have  noted  that  in  extreme  cases  of  poisoning  convulsions  have  taken 
place,  and  that  death  occurred  from  the  arrest  of  respiration. 

The  mouth,  stomach  and  intestines  are  directly  affected  by  the 
use  of  tobacco.  Upon  the  saliva  there  is  at  the  start  a  primary  stim- 
ulation and  increased  flow,  and  later  paralysis  of  the  action  of  these 
glands  in  habitual  users.  By  its  close  contact  with  the  mucous  mem- 
brane it  has  an  irritating  influence  upon  them,  and  the  buccal-tonsillar- 
pharyngeal  membrane  usually  appears  reddened  and  congested,  with 
an  unusual  prominence  of  veins.  This  is  true  of  the  nasal  mucous 
membrane  where  smoke  is  inhaled  and  blown  through  the  nose,  or 
where  snuff  is  used.  Chewers  oftentimes  show  the  displeasing  and  in 
some  instances  disgusting  effects  upon  the  teeth,  which  become  in- 
tensely discolored  and  are  often  worn  nearly  to  a  level  with  the  gums. 
It  has  been  claimed  that  smoking  predisposes  to  cancer  of  the  lip, 
but  to  this  the  author  takes  exception,  believing  that  if  it  is  brought 
about  by  smoking  it  is  due  to  the  irritation  and  to  nothing  inherent  in 
tobacco  itself.  Upon  the  stomach  we  may  get  localized  effects  from 
swallowing  sputum  containing  small  bits  of  tobacco  or  impregnated 
with  the  smoke  or  toxic  products  of  combustion.  This  is  especially 
true  of  pipe  and  cigar  smokers  and  tobacco  chewers.  As  a  result, 
tobacco  users  are  frequent  subjects  of  chronic  gastritis,  indigestion 
and  other  symptoms,  of  which  hyperacidity,  flatulence,  weight,  heavi- 
ness  and  a  sense  of  constriction  or  tightness  are  most  frequent.  These 
symptoms  are  noted  in  those  who  are  tobacco  users  alone,  but  are 
much  more  common  where  alcohol  is  an  added  factor.  Tobacco  has 
a  mild  laxative  influence  upon  the  intestinal  tract,  and  this  is  often 
offered  as  an  excuse  by  old  smokers  for  a  continuance  of  the 
habit. 

Upon  the  respiration  we  find  that  its  action  is  first  quickened, 
while  if  from  continued  use  poisoning  results  it  becomes  slower  and 
slower.  It  is  the  arrest  of  respiration  that  causes  death  in  lethal  doses. 
Where  the  smoke  of  tobacco  is  inhaled  its  action  is  most  marked 
i  the  upper  respiratory  passages,  showing  chronic  glandular  in- 
flammation, the  larynx  being  especially  irritated.  Cigarette  inhalers 
oftentimes  show  this  phase  of  tobacco  irritation  to  a  marked  degree, 
the  cause  of  the  irritation  being  due  to  the  presence  in  the  smoke 
of  heat  and  other  chemical  irritants,  the  result  of  combustion.  The 
author  has  seen  a  few  cases  in  girls  and  women,  subjects  of  this  irri- 


DRUG  HABITS.  449 

tation,  due  to  the  inhalation  of  tobacco  dust  while  working  in  tobacco 
manufactories. 

Upon  the  heart  and  circulation  moderate  doses  cause  a  slowing 
of  the  pulse,  followed  by  a  return  to  the  normal  or  to  a  rate  slightly 
above  the  normal.  The  heart  is  slowed  by  the  depressive  and  inhib- 
itory influence  coming  through  the  vagus  nerve  and  ganglia ;  later  it 
paralyzes  the  centers  and  accelerates  the  heart's  action  through  the 
sympathetic  nervous  system.  Blood  pressure  is  temporarily  increased 
by  tobacco,  owing,  it  is  claimed,  to  the  stimulation  of  the  vasocon- 
strictor ganglion  cells,  and  the  pressure  may  rise  to  two  and  one-half 
times  the  normal,  the  rise  in  pressure  being  due  to  paralysis  of  the 
ganglia.  It  would  seem  that  constant  repetition  of  this  practice  might 
produce  widespread  and  serious  effects  upon  the  blood-vessels  them- 
selves.  Because  of  the  vascular  contraction  and  peripheral  resist- 
ance, the  work  of  the  heart  is  greatly  increased,  and  we  would  expect 
cardiac  hypertrophy,  but  the  author's  experience  has  been  that  this 
is  not  usually  present  in  the  habitual  user.  My  judgment  is  that  the 
constant  user  of  tobacco  is  on  the  high  road  to  deteriorating  the  mus- 
cular power  of  his  heart,  this  being  followed  by  dilatation.  The  way 
is  long  and  the  deviations  many,  but  it  is  more  frequent  than  is  gen- 
erally believed  by  medical  men.  It  may,  however,  be  stated  that  the 
majority  of  cases  are  "functional"  in  character,  for  on  post-mortem 
pathological  lesions  are  rarely  found.  Huchard1  is,  in  the  writer's 
opinion,  correct  in  the  statement  that  the  constantly  repeated  rise  of 
blood  pressure  may  and  does  result  in  arterio-sclerosis. 

The  symptoms  most  commonly  observed  are  those  of  the  "irritable 
heart,"  associated  with  digestive  and  nervous  manifestations,  the  most 
common  complaint  being  pain  in,  over  and  around  the  heart,  from 
the  very  mildest  to  severe  attacks,  that  look  like  angina.  These  attacks 
are  accompanied  by  pallor,  cold  extremities,  sweating,  muscular  weak- 
ness, headache,  and  small,  feeble  and  irregular  pulse.  Ordinarily 
physical  examination  of  the  heart  may  show  nothing  abnormal, 
although  the  commonest  manifestations  are  rapidity,  irregularity  and 
intermittence,  especially  after  slight  exertion.  The  author  has  seen 
cases  that  presented  such  irregularity  and  disorder  in  rate  and  rhythm 
as  to  require  most  careful  differentiation.  One  of  the  most  common 
forms  is  two  to  three  good  beats,  intermission,  followed  by  three  to 
seven  quick,  small  and  weak  beats.  Almost  any  form  of  irregularity 
may  be  present.  At  this  stage  blood  pressure  is  usually  low.  In 
listening  to  the  tobacco  heart  the  experienced  auscultator  will  have  no 
difficulty  in  detecting  a  tobacco  heart,  for  in  addition  to  the  above 
it  will  be  noted  that  the  heart  seems  to  have  a  hesitating,  labored 
action  or  gait,  entirely  different  from  the  ordinary  heart  beat  of 
organic  disease.     These  effects  are  much  more  pronounced  in  young 

1  Huchard:  Bull.   Med.,  Paris,  1889,  iii,  643;  Malad.  du  Coeur,  Paris,   1889. 


450  PRACTICAL  HYDROTHERAPY. 

men,  youths  and  women,  owing  to  their  sensitiveness  to  the  products 
of  tobacco  combustion. 

Upon  the  nervous  system  the  first  effect  of  tobacco  is  that  of 
general  stimulation,  especially  manifested  through  the  respiratory  and 
cardiac  activities,  heightening  the  cerebral  functions,  the  lower  brain 
centers  and  spinal  cord ;  this  is  later  followed  by  depression  of  varying 
degree.  The  use  of  tobacco,  by  its  powerful  depressant  influence 
upon  the  motor  centers,  produces  a  more  or  less  characteristic  tremor, 
fine  and  vibratory  in  character.  As  a  direct  active  causative  agent  of 
functional  nervous  disturbances  we  may  mention  that  vertigo  is  not 
an  uncommon  result  of  its  use.  Insomnia  occurs  with  a  fair  degree 
of  frequency,  even  in  those  who  are  constantly  addicted  to  its  use, 
and  every  smoker  knows  that  a  strong  cigar  often  acts  as  an  excitant 
of  the  brain.  Neuralgia  can  occasionally  be  directly  traced  to  the  use 
of  this  weed,  as  can  violent  and  alarming  attacks  described  by  Peter, 
and  called  "tobacco  angina."  Peter  calls  attention  to  the  difference 
between  this  angina  and  the  angina  of  true  cardio-vascular  disease, 
for  no  man  in  an  attack  of  true  angina  writhes  or  moans  aloud,  nor 
does  a  true  attack  last  long  enough  for  maneuvres  of  this  kind.  The 
key-note  of  true  angina  is  a  terror-stricken  stillness,  the  patient  not 
daring  to  even  breathe  lest  he  may  die  in  the  act.  Headache,  muscular 
tremor  and  a  state  of  general  debility  are  not  uncommon  outcomes 
of  the  excessive  tobacco  use  in  the  susceptible.  Insanity  has  been 
attributed  frequently  to  tobacco,  especially  cigarettes,  but  the  author, 
from  no  small  experience,  can  state  that  he  has  never  seen  a  case,  nor 
can  he  find  any  account  in  Kraepelin2  of  tobacco  as  such  a  cause;  in 
fact,  he  says  that  he  has  never  seen  anything  of  the  kind.  In  cases  of 
insanity  the  influence  of  tobacco  is  probably  secondary  or  simply 
cumulative,  in  that  it  assists  other  factors  in  producing  a  general 
physical  and  mental  break-down. 

There  is  no  gainsaying  the  fact  that  there  are  a  great  many  persons, 
cultivated,  cultured  and  illiterate,  but  especially  the  two  former,  who 
derive  great  pleasure  and  mental  satisfaction  from  the  use  of  tobacco. 
Many  who  work  with  the  head  or  the  hands  become  irritable  and 
rundown,  so  that  anything,  from  the  office  to  the  simplest  detail  at 
home,  seems  to  set  them  awry.  In  this  abnormal  psychological  state 
tobacco  seems  to  exert  a  soothing  and  sedative  influence  that  is  con- 
ducive not  alone  to  his  individual  comfort,  but  to  the  happiness  of 
those  about  him.  In  this  wise  tobacco  does  a  good  service  to  mankind. 
There  are  other  individuals  whose  mental  make-up  is  such  that  they 
have  great  difficulty  in  concentrating  their  minds  and  thoughts  upon 
their  work,  and  to  these  tobacco  seems  to  arrest  and  focus  the  in- 
tellectual powers,  so  that  they  are  capable  of  definite  and  satisfactory 
work.    A  number  of  writers,  lay  and  medical,  have  assured  the  author 

2  Kraepelin,   Emil:   "Clinical  Psychiatry,"   1904. 


DRUG  HABITS.  451 

that  without  tobacco  their  best  efforts  would  have  amounted  to  nothing, 
and  it  may  be  said  in  passing  that  no  other  substance,  narcotic  or 
anesthetic,  is  yet  known  which  would  serve  this  purpose  and  do  so 
little  damage.  This  is  a  mere  idea,  the  result  of  long  habit.  Most 
military  writers  admit  that  it  is  of  decided  value  to  soldiers,  helping 
them  to  pass  the  time  in  monotonous  camps ;  when  exposed  to  severe 
weather  and  when  food  is  scarce  it  acts  as  a  preventive  of  the  pangs 
of  hunger.  Many  a  soldier  has  testified,  in  language  that  inadequately 
conveys  the  idea,  of  the  comfort,  consolation  and  companionship  the 
pipe  has  given  when  exposed  to  severe  weather  in  the  trenches,  and 
it  has  seemed  to  the  author  from  all  the  facts  he  can  gather  that 
tobacco,  under  these  circumstances,  has  done  little  if  any  harm. 
Socially  it  is  objectionable  on  account  of  its  odor  and  the  promiscuous 
spitting  that  is  indulged  in. 

Upon  the  eyes  the  effect  of  tobacco  is  universally  recognized,  its 
action  being  to  produce  the  tobacco  amblyopia,  amaurosis  and  dry 
conjunctivitis  known  as  "smoker's  sore  eye."  This  amblyopia  is  of 
a  specific  type  and  is  most  common  in  men  beyond  the  age  of  thirty- 
five  who  are  smokers  rather  than  chewers.  There  is  a  dimness  of 
vision,  and  the  patient  frequently  sees  best  at  night  and  in  a  dim  light. 
The  most  characteristic  finding  is  a  central  scotoma  for  color,  a  con- 
dition which  is  almost  pathognomonic  of  toxic  amblyopia.  The 
ability  to  distinguish  colors  is  usually  lost,  first  green,  then  red,  and 
finally  blue.  The  scotomata  may  later  exist  for  form  as  well  as  color 
if  neglected.  This  impairment  of  sight  and  color  sense  from  the 
center  through  the  whole  of  the  nerve  fibers  leads  rarely  to  absolute, 
yet  generally  to  practical  blindness.  Tobacco  amaurosis  is  the  gravest 
of  the  mischiefs  of  tobacco. 

The  prognosis  of  the  functional  disturbances  resulting  from  the 
over-indulgence  in  tobacco  is  usually  good.  The  various  symptoms 
of  nervous  depression,  cardiac  disturbance,  weakness,  palpitation  and 
irritability  rapidly  disappear  under  the  institution  of  treatment  and 
the  cessation  of  the  use  of  tobacco.  The  amblyopia  usually  recovers 
completely  if  proper  treatment  is  instituted  early  enough,  but  if  the 
habit  is  persisted  in  a  high  grade  of  deficiency  may  become  permanent. 

The  principles  underlying  the  treatment  of  the  tobacco  habit  are 
few  and  simple— cessation  of  its  use,  active  elimination  and  tonic 
reconstruction.  The  author  has  never  seen  the  slightest  harm  result 
from  the  immediate  "cessation  of  tobacco,  and  in  those  who  may  be 
denominated  "end-to-end  smokers"  his  experience  has  been  that  the 
"taper  end"  is  the  larger.  Physicians  should  do  all  in  their  power  to 
prevent  the  use  of  tobacco,  especially  by  young  persons,  girls  and 
women.  Tobacco  is  injurious,  especially  to  those  suffering  from 
gastric  disturbances,  cardiac  abnormalities,  anemia,  and  convalescents 
from  acute  diseases.     Athletes  should  never  use  tobacco.     The  com- 


452  PRACTICAL  HYDROTHERAPY. 

bination  of  tobacco  and  alcohol  is  to  be  especially  denounced,  as  one 
accentuates  the  evil  effects  of  the  other.  Smokers  would  decrease  the 
dangers  of  tobacco  use  if  they  would  use  pipes  with  long  stems  and 
keep  them  clean,  avoid  notoriously  strong  tobacco  and  not  inhale  the 
smoke.  Cigars  should  not  be  smoked  too  close  to  the  end  nor  held 
too  long  in  the  mouth.  The  "dry  smoke"  is  to  be  avoided.  Many 
writers  advise  that  smoking,  if  indulged  in.  be  only  after  meals,  as 
this  decreases  the  quantity  of  tobacco  smoked  and  any  irritating  saliva 
which  is  swallowed  comes  into  less  intimate  contact  with  the  mucous 
membrane  of  the  stomach.  Smokers  are  warned  to  keep  their  cigars 
dry  and  to  take  them  out  of  the  mouth  between  whiffs.  Thomas  has 
recently  patented  his  method  of  preventing  tobacco  poisoning;  it  is 
based  on  the  fact  that  certain  iron  salts  hold  in  combination  bases  of 
tobacco  smoke.  Cotton  impregnated  with  ferric  chloride  is  an  efficient 
agent  for  this  purpose;  it  holds  back  77.78  per  cent,  of  nicotine  and  its 
bases;  86.11  per  cent,  of  ammonia.  A  tampon  of  cotton  dipped  in 
ferric  chloride  and  applied  to  the  tip  end  of  the  cigar  will  thus  afford 
efficient  protection  against  tobacco  poisoning.  It  is  even  claimed  that 
it  improves  the  flavor  of  a  cheap  cigar,  making  it  more  like  that  of 
genuine  Havana  tobacco,  removing  much  of  the  nicotine  and  rank- 
smelling  chemicals  that  are  found  in  cheap  tobacco. 

The  hydrotherapeutic  treatment  of  chronic  tobacco  poisoning  may 
be  satisfactorily  carried  out  at  home  by  the  institution  of  the  full  hot 
bath  at  a  temperature  of  100°  to  104°  F.  for  ten  minutes,  followed 
by  a  rapid  cold  sponge  and  vigorous  friction  with  a  crash  towel. 
Commence  the  cold  sponge  at  80°  F.  and  drop  five  degrees  each  bath, 
until  60°  is  reached.  This  will  establish  reaction.  In  the  homes  that 
possess  a  shower  bath,  the  hot  full  bath  may  be  followed  by  it  at 
69°  F.,  supplemented  with  vigorous  friction.  In  the  institutional 
rna  nagement  of  these  cases  our  aim  is  to  use  sweating  procedures,  such 
as  the  electric  light  bath,  superheated  dry  air  body  apparatus,  hot  air 
or  vapor  bath,  followed  by  tonic  measures.  The  author  has  decided 
preferences  for  the  following  method  of  treatment:  Electric  light 
bath  until  moderate  perspiration  is  noticed,  followed  by  the  full  warm 
bath  at  100°  F.  for  five  minutes  ;  dry  thoroughly  thereafter.  One  or 
two  of  such  preliminary  treatments  is  usually  sufficient,  and  may  be 
followed  by  the  use  of  the  electric  light  bath  until  free  perspiration 
ensues,  then  the  horizontal  rain  bath  at  100°  to  104°  F.  for  one  and 
one-half  minutes,  pressure  twenty-five  pounds,  reduced  to  80°  F.  for 
one-fourth  minute.  Reduce  the  temperature  of  the  cold  water  two 
degrees  daily  until  60°  F.  is  reached,  at  the  end  of  which  time,  if  the 
patient  is  fairly  robust  or  reacts  well,  we  may  add  to  the  above  treat- 
ment the  jet  douche  to  the  spine  and  posterior  aspect  of  the  lower 
limbs  at  a  temperature  of  60°  F.,  pressure  twenty-five  pounds,  for 
five  to  ten  seconds.     It  is  astounding  how  rapidly  and  satisfactorily 


DRUG  HABITS.  453 

patients  respond  to  this  treatment.  It  will  be  noticed  that  the  skin 
clears,  the  eye  brightens,  the  cardiac  action  improves,  digestion  betters 
and  elimination  increases.  J  have  noted  the  fact  that  after  the  use 
of  the  electric  light  bath  the  odor  of  tobacco  is  plainly  detected  when 
the  bath  door  is  opened. 

Craving  for  tobacco  can  oftentimes  be  overcome  by  the  free  use 
of  soda  water,  fruit  juices,  chewing  gum,  sucking  acid  drops,  and 
drinking  hot  milk  at  bedtime. 

There  is  no  question  but  what  the  forbidding  of  smoking  by 
minors  and  its  legal  enforcement  would  result  in  a  decrease  in  smoking 
and  do  away  with  many  of  its  evil  effects  in  after  years. 

Coffee. 

Coffee  is  the  seeds  of  the  Caffca  Arabica,  a  good  sized  shrub  or 
small  tree,  with  spreading  and  horizontal  branches,  dark  green, 
glabrous  and  nearly  evergreen  leaves.  The  white  flowers  grow  in 
close  clusters ;  further  down  are  the  green  leaves  and  then  the  red 
fruits,  the  whole  being  highly  ornamental.  The  fruit  is  oblong,  round 
and  purplish,  enclosing  two  seeds  about  2  cm.  or  one-half  to  three- 
fourths  of  an  inch  in  length.  This  shrub  is  a  native  of  tropical  Africa, 
though  it  is  cultivated  in  most  of  the  warm  places  of  the  earth,  es- 
pecially Java  and  Brazil.  The  favorite  brands  are  those  of  Mocha 
and  Java,  the  latter  being  one  of  the  most  delicate  and  the  former 
one  of  the  richest  flavors  of  the  different  coffees.  Ageing  the  green 
berry  before  roasting  improves  it.  Coffee  is  raised  in  orchards,  two 
crops  being  usually  produced  each  year.  The  most  interesting  in- 
gredient is  caffeine ;  besides  this  there  is  dextrin,  a  large  amount  of 
albuminoid  matter  and  a  volatile  oil.  Roasting  changes  the  character 
of  coffee,  dissipating  some  of  its  caffeine,  most  of  its  water,  and 
forming  fragrant  decomposition  products,  the  sugar  and  dextrin  being 
changed  to  caramel.  Pure  ground  and  roasted  coffee  is  partaken  of 
in  the  form  of  a  decoction  and  an  infusion.  In  Arabia  a  decoction 
of  the  green  berry  is  drunk,  but  the  generality  of  peoples  roast  the 
bean,  grind  it  and  then  either  put  it  into  boiling  water  or  bring  the 
water  containing  the  grounds  to  a  boil,  straining  same,  after  which 
it  is  drunk.  Soft  water  should  always  be  used.  Coffee  in  moderate 
quantities  is  a  refreshing,  stimulating,  enlivening  and  restorative 
beverage,  without  apparent  reactionary  depression,  though  it  is  more 
heating  and  heavier  than  tea  to  the  stomach.  Coffee  possesses  some 
antiseptic  properties.  In  small  doses  it  quickens  the  action  of  the 
heart,  raises  arterial  tension,  increases  the  quantity  of  blood  in  the 
brain,  stimulates  cerebral  functions,  increases  respiration  and  the  se- 
cretion of  urine.  Large  doses  depress  the  heart  and  circulation,  lower 
the  blood  pressure  and  weaken  the  circulation.  "Coffee  is  excreted  un- 
changed in  the  bile  and  urine  and  is  a  reliable  hydrngogue  diuretic, 


454  PRACTICAL  HYDROTHERAPY. 

acting  by  stimulation  of  the  secreting  apparatus  in  the  kidney  as  well 
as  by  generally  raising  the  arterial  tension."  3 

The  use  of  coffee  is  well-nigh  universal,  and  in  a  great  many 
instances  we  may  say  that,  unfortunately,  its  use  is  excessive.  Many 
persons  are  sensitive  to  its  action ;  in  these  it  produces  nervousness, 
wakefulness,  palpitation,  weak  action  of  the  heart,  dyspeptic  disturb- 
ances, and  in  some  cases  confusion  of  ideas.  Where  persisted  in  it 
may  interfere  with  the  vision.  Excessive  coffee  users  are  observed 
to  suffer  from  tremor,  weakness  of  the  lower  limbs,  a  sense  of  falling, 
headache,  frequently  very  severe,  mental  agitation  and  marked  de- 
pression. The  color  of  the  skin  is  dark  and  "bilious,"  they  are  gen- 
erally haggard,  there  is  emaciation,  and  the  features  look  pinched. 
The  appetite  falls  off  even  to  the  extent  of  anorexia ;  there  is  nausea, 
hot  dry  mouth,  much  thirst,  feverishnesss  and  coated  tongue.  There 
are  usually  symptoms  of  acute  catarrh  and  chronic  constipation.  Car- 
diac palpitation,  intermittence  and  weak  action  of  the  heart  are  very 
common. 

The  treatment  must  commence  with  immediate  cessation  of  coffee 
drinking,  and  this  in  itself  goes  quite  a  distance  in  bringing  about 
recovery.  Patients  should  be  instructed  to  drink  large  quantises  of 
effervescent  and  carbonated  waters  and  be  at  once  placed  upon  elimin- 
ative  and  tonic  hydrotherapy,  which  should  bring  about  complete 
restoration  in  a  very  short  time,  provided  no  weakness  or  other  serious 
trouble  exists.  Guided  by  the  condition  of  the  individual,  we  would 
commence  with  the  electric  light  bath  or  the  hot  air  bath  until  free 
perspiration  takes  place.  If  the  patient  is  weak  this  should  be  followed 
by  the  application  of  the  cold  sponge  at  80°  to  60°  F.,  rapidly  per- 
formed, with  subsequent  vigorous  friction  with  a  crash  towel,  patients 
resting  for  an  hour  after  the  bath.  A  treatment  or  two  of  this  char- 
acter prepares  the  individual  for  the  next  step,  or,  where  they  are 
vigorous,  treatment  may  be  commenced  with  the  following:  Electric 
light  bath  until  free  perspiration ;  horizontal  rain  bath  at  a  tempera- 
ture of  104°  to  106°  F.  for  one  and  one-half  to  two  minutes,  reduced 
to  80°  F.  for  one-fourth  minute,  pressure  twenty  pounds ;  reduce  the 
temperature  two  to  three  degrees  daily  to  60°  F.  and  increase  the 
pressure  one  pound  daily  until  thirty  pounds  is  registered.  By  this 
time  the  patient  should  have  so  far  progressed  in  reactive  capacity,  or 
if  strong  and  vigorous  th»  following  may  be  used  early  in  the  treat- 
ment :  Electric  light  bath  to  the  point  of  free  perspiration ;  horizontal 
rain  bath  at  104°  to  105°  F.,  for  one  minute,  reduced  to  60°  F.  for 
one- fourth  minute,  pressure  thirty  pounds,  followed  by  the  jet  douche 
at  60°  F.,  same  pressure,  to  the  spine  and  posterior  aspect  of  the  lower 
limbs ;  finish  the  treatment  with  a  gentle  fan  douche  to  the  chest  and 

3   Brunton,  T.  Lauder:  "Disorders  of  Assimilation,  Digestion,"  etc.,  1901;  Coffee,  p.   176. 


DRUG  HABITS.  455 

abdomen.  This  is  a  powerful  treatment  and  is  to  be  administered  in 
selected  cases  only. 

Where  digestive  disturbances  are  present  the  general  treatment 
above  outlined  will  usually  be  sufficient,  but  should  they  become 
troublesome  in  spite  of  the  treatment  we  may  apply  Neptune's  girdle 
at  a  temperature  of  60°  F.,  worn  during  the  night. 

Insomnia  and  nervous  manifestations  require  nothing  more  than 
general  treatment;  if  they  persist  after  two  weeks'  careful  management 
of  the  case  they  must  then  be  treated  along  the  lines  laid  down  in 
other  sections  of  this  work. 

Tea. 

Tea  is  the  prepared  and  dried  leaves  of  Thea  Sinensis;  is  a  shrub 
two  to  five  feet  in  height,  the  leaves  of  which  are  evergreen,  thick, 
leathery,  smooth  and  lanceolate.  Tea  is  a  native  of  Asia,  but  is  now 
cultivated  in  many  places  of  the  world,  especially  in  China,  Japan  and 
India.  Our  earliest  knowledge  of  tea  comes  from  the  Chinese.  It  is 
planted  and  when  two  or  three  years  old  the  leaves  are  plucked,  and 
if  the  tea  is  to  be  green  are  at  once  dried  over  a  hot  stove.  Black  tea 
leaves  are  placed  in  little  heaps,  allowed  to  wilt  and  ferment  and  dried 
as  above.  The  shape  of  tea  is  attained  by  compressing  and  rolling 
the  leaves  in  the  hand  or  upon  a  table  until  they  are  crumpled  into  the 
little  rolls  or  wads,  of  which  the  commercial  article  consists.  Tea  con- 
tains thein  from  ]/2  to  3  per  cent,  and  tannin  up  to  14  per  cent. 

Very  close  attention  should  be  paid  to  the  mode  of  preparation  in 
order  that  the  infusion  contain  as  little  tannin  as  possible.  It  should  be 
prepared  by  pouring  boiling  water  in  suitable  quantities  upon  the  tea, 
allowing  it  to  stand  for  five  to  ten  minutes  and  then  decanted.  Tea  is 
less  stimulating  and  more  astringent  than  coffee.  When  drunk  in  very 
moderate  quantities  by  those  persons  with  whom  it  does  not  disagree, 
tea  is  a  cheerful,  reviving,  exhilarating  restorative.  A  part  of  hot  tea's 
reviving  influence  is  due  to  the  warmth,  though  it  will  be  found  that 
cold  tea  is  reviving  and  restorative  when  drunk  on  the  march  or  during 
a  day's  shooting.  Arctic  explorers  prefer  tea  as  a  beverage,  and  it  is 
claimed  that  tea  is  the  most  useful,  grateful  and  recuperative  of  all 
the  beverages  when  properly  prepared  and  judiciously  drunk.  The 
physiological  action  of  tea  is  similar  to  that  of  coffee,  and  need  not  be 
here  repeated.  The  astringent  contained  in  tea  interferes  seriously 
with  the  digestion,  bringing  about  acid  dyspepsia  accompanied  by  flatu- 
lence, heartburn,  nausea,  anorexia,  gastralgia  and  abdominal  pain. 
Constipation  nearly  always  follows  in  its  wake. 

Upon  the  nervous  system  it  produces  mental  depression,  palpita- 
tion, nervous  irritability,  insomnia,  tremor,  cephalgia,  anxiety  or  dread, 
and  sometimes  depression  almost  amounting  to  melancholia. 

Upon  the  heart  and  circulation  it  may  produce  palpitation,  inter- 


456  PRACTICAL  HYDROTHERAPY. 

mittence  and  weakness.  Many  patients  who  are  addicted  to  the  ex- 
cessive use  of  tea  are  subject  to  attacks  of  horrible  "night  mare." 
These  individuals  are  usually  markedly  anemic,  tend  to  emaciation, 
suffer  from  physical  depression,  with  sallowness  and  inactive  skin.  All 
teas,  according  to  Brunton,4  are  equally  injurious. 

The  treatment  of  this  habit  and  its  pathological  manifestations  is 
similar  to  and  identical  with  that  of  coffee,  which  has  been  considered 
in  the  preceding  section. 

In  the  summing  up  of  the  action  of  tea  and  coffee,  we  may  briefly 
say  that  when  properly  prepared,  taken  in  moderation  by  those  who 
are  not  peculiarly  sensitive,  their  action  is  that  of  useful  and  agree- 
able beverages.  When  taken  in  too  great  quantities  they  are  apt  to 
produce  nervous,  digestive,  circulatory  and  functional  disturbances 
of  various  kinds,  oftentimes  serious  in  character.  In  such  instances 
they  should  be  discontinued  and  their  use  never  resumed.  Tea  and 
coffee  drinking  are  habits  that  can  be  more  easily  given  up  than  any 
other  addiction.  Where  patients  desire  substitutes,  some  of  the  cereal 
imitations  can  be  given. 

4  Brunton,  T.  Lauder:   "Disorders  of  Assimilation,  Digestion,"  etc.,  1901;  Tea,  p.   171. 


CHAPTER  XXI. 

ALCOHOLISM. 

Acute    Alcoholic    Intoxication  (Drunkenness);    Acute    Alcoholic 
Mania  (Mania  a  Potu) ;  Acute  Alcoholic  Delirium  (Delirium 
Tremens);  Chronic  Alcoholism;  Chronic  Drunken- 
ness  and  Inebriety. 

It  lias  been  said  that  if  all  the  pain,  sorrow  and  degradation  in  the 
world  were  carefully  investigated,  one-third  would  be  found  to  have 
been  caused  by,  flow  from  or  associated  with  alcoholism.  For  many 
decades   the   question   was   propounded — 

"Can  sorrow  from  the  goblet  flow, 
Or  pain  from  beauty's  eyes?" 
And  ever  since  the  uninitiated  have  been  trying  to  make  the  intelligent 
and  thoughtful  physicians  and  scientists  believe  that  alcohol  has  not 
produced  all  the  mischief  with  which  it  is  credited.  There  is  no  form 
of  poison  which  is  so  widely  spread  among  the  people,  that  is  so 
rapidly  increasing  at  the  present  time,  as  the  peculiar  phenomena, 
toxic  in  origin,  exhibited  by  those  who  are  addicted  to  the  various 
preparations  of  alcohol.  From  a  very  extended  experience  the  author 
believes  that  physicians,  as  a  rule,  not  only  do  not  comprehend  or 
appreciate  the  extent  of  alcoholism,  nor  do  they  understand  its  many 
effects.  It  may  be  stated  without  peradventure  of  a  doubt  that  alco- 
hol is  the  most  powerful  of  all  poisons  which  disturb  the  mental  func- 
tion, produce  physical  degeneration,  destroy  brain  structure,  and  in- 
crease moral  obliquity.  Its  action  is  not  limited  to  the  individual, 
but  its  influence  percolates  to  the  second  and  third  generations,  pro- 
ducing congenitally  defective  children,  the  subjects  of  morbid  craves 
for  opiates  or  stimulants,  or  handicapped  by  some  peculiar  nerve 
affliction,  or  with  a  strong  tendency  to  tuberculosis  or  mental  troubles. 
Dana  has  said  that  "if  alcoholism  were  entirely  cut  out,  10  per  cent. 
of  all  mental  maladies  would  be  removed  at  one  fell  swoop,"  and  the 
author  is  rather  inclined  to  believe  that  this  applies  with  considerable 
pertinency  to  many  other  forms  of  disease.  Its  influence  in  the  pro- 
duction of  nervous  diseases  is  baneful,  direct  and  potent.  It  may  be 
stated  that  it  is  more  often  a  predisposing  factor  in  heredity  than  it 
is  given  credit  for,  and  upon  the  individual  its  effects  are  mild  or 
severe  in  proportion  to  the  amount  that  is  ingested. 

By  the  term  alcoholism  is  meant  those  various  pathological  changes, 
(457) 


458  PRACTICAL  HYDROTHERAPY. 

processes  and  symptoms  attendant  upon  or  caused  by  its  intemperate 
consumption,  temporary  or  long  continued.  Inebriety  is  an  entirely 
different  condition,  being  the  craze  or  craving  of  the  nervous  system 
for  stimulation.  It  has  improperly  been  termed  "dipsomania."  It 
should  be  kept  clearly  in  mind  this  difference  between  alcoholism  and 
inebriety — the  alcoholic  may  become  an  inebriate  or  insane,  but  the 
true  inebriate  is  already  mentally  unbalanced  before  he  commences 
to  drink.  Inebriety  may  therefore  be  considered  a  pathological  state 
or  condition  of  the  neurons  of  the  brain  that  impels  the  subject  to 
drink — "driven  to  drink."  There  is  an  impression  abroad  in  the  med- 
ical profession  that  the  primary  changes  brought  about  by  alcohol 
are  purely  functional  in  character,  but  it  should  be  borne  in  mind 
that  the  constant  repetition  of  functional  disorder  may  create  organic 
disease.  This  is  doubly  true  in  alcohol,  which  by  repetition  and  direct 
action   creates  structural   changes. 

Alcohol  of  the  Pharmacopeias  is  one  of  a  series  of  hydro-carbon 
compounds,  all  of  which  have  as  their  basis  a  radical  called  ethyl, 
whose  chemical  composition  is  expressed  by  the  formula  CH.  It  is 
known  in  the  British  Pharmacopeia  as  rectified  spirit  or  rectified 
spirits  of  wine,  from  its  being  obtained  by  distillation,  with  subsequent 
rectification  or  purification,  from  a  mash  of  potatoes,  grain  or  wine. 
Alcohol  is  usually  drunk  in  different  diluted  forms  known  as  bev- 
erages, which  are  grouped  according  to  the  percentages  of  alcohol 
they  contain.  The  physiologic  action  of  alcoholic  beverages  is  that 
of  a  combination  of  effects,  for  they  contain  sugar,  dextrin,  salts, 
ether,  amylic,  butylic,  propylic,  ethylic  and  methylic  alcohols.  Sugar 
and  dextrins  may  be  considered  as  available  as  food,  the  ethers  and 
salts  may  increase  digestion,  but  the  balance  are  dangerous  and  may 
at  any  time  become  toxic.  All  kinds  of  alcohol  are  poisonous,  though 
the  heavier  spirits  (amylic  and  butyric)  are  more  poisonous  than  the 
lighter  ones  (ethylic  and  methylic).  It  is  equally  true  that  spirits  are 
more  toxic  than  equal  quantities  of  wines  and  beers,  owing  to  the 
greater  concentration  and  quantity  of  alcohol  in  the  former. 

The  amount  of  alcohol  that  can  be  consumed  by  the  tissues  varies 
according  to  the  individual,  but  it  may  be  roughly  estimated  at  one 
ounce  of  absolute  alcohol  for  a  healthy  individual  in  twenty-four 
hours,  for  women  one-third  less.  Bartholow  claims  that  all  above 
this  amount  is  an  excess  and  dangerous.  In  amounts  of  two  ounces 
of  whisky  or  brandy  many  authorities  consider  it  to  act  as  a 
"food(  ?)'",  as  it  is  used  up  in  the  economy,  producing  heat  and  en- 
ergy; but  it  should  be  borne  in  mind  that  this  is  frequently  produced 
at  the  expense  of  healthy  cellular  activity,  and  that  even  if  it  is  con- 
sidered in  the  light  of  a  "food,"  its  cost  from  this  point  of  view  has 
been  calculated  to  be  eight  times  that  of  bread.  Young  and  middle- 
aged  people  are  much  better  off  without  alcohol ;  elderly  people  can 


ALCOHOLISM.  459 

consume  a  small  amount  at  times  with  benefit.  The  food  value  of 
alcohol  has  been  argued  pro  and  con,  and  in  this  connection  it  may 
be  stated  that  the  experiments  of  Vogt  show  that  while  the  capacity 
for  physical  work  is  increased  about  one-third  after  the  ingestion  of 
alcohol,  in  ten  minutes  this  increase  has  almost  entirely  disappeared, 
and  in  addition  the  one  ounce  of  alcohol  ingested  greatly  reduced  the 
perceptive  capacity,  calculation  and  the  ability  to  reckon  accurately. 
Gluck  has  pointed  out  that  when  alcohol  is  added  to  fatigue  products 
of  muscles,  depressing  effects  become  very  marked.  Rest  after  taking 
alcohol  prevents  any  noticeable  diminution  in  strength,  but  if  action 
demands  the  utilization  of  strength,   fatigue  rapidly  ensues. 

Indulgence  in  alcohol  is  marked  by  various  kinds  of  drinking,  but 
is  divided  by  Kerr1  into  those  known  as  "convivial"  drinking — that 
is  to  say,  drinking  associated  with  conditions  of  relative  luxury,  and 
which  often  leads  to  drunkenness  but  does  not  tend  very  much  to 
chronic  alcoholism ;  "industrial"  drinking,  associated  with  conditions 
of  relative  misery  and  bad  industrial  circumstances,  which  leads  less 
frequently  to  drunkenness,  but  tends  rather  to  chronic  and  constant 
intoxication.  These  forms  of  drinking  may  be  again  subdivided  into 
private  and  public,  the  latter  being  largely  confined  to  the  middle 
and  lower  classes,  though  it  is  not  entirely  so  limited.  The  convivial 
drinker  partakes  of  his  liquor  in  clubs,  at  dinners  with  friends  and 
boon  companions.  The  secret  drinker,  as  the  name  indicates,  imbibes 
alone  and  away  from  prying  eyes.  This  form  of  drinking  is  especially 
prevalent  among  women.  Another  form  is  that  of  "night  drinking," 
the  person  affected  performing  his  labors  during  the  day  and  con- 
suming the  liquor  when  through  with  his  work.  Many  of  these  "drink 
deep  wassail."  The  occasional  convivial  drinker  seeks  companion- 
ship while  tasting  of  the  "flowing  bowl,"  and  is  generally  more  or 
less  noisy  and  uproarious  when  intoxicated.  The  confirmed  chronic 
drinker  drinks  whenever  opportunity  presents  or  finances  permit, 
while  inebriates  drink  when  the  attack  seizes  them.  The  chronic 
drinker  may  so  injure  his  brain  structurally  that  he  may  become  after 
the  passage  of  time  an  inebriate,  but  the  true  inebriate  is  one  who 
was  born  with  an  unbalanced  brain,  and  who  will  probably  transmit 
to  his  children  the  disease  from  which  he  suffers,  or  some  nervous 
handicap.  The  chronic  alcoholic,  drinking  spirits,  has  a  rather  char- 
acteristic appearance,  being  thin,  sometimes  to  emaciation,  with  a 
fiery  or  bluish  countenance  that  readily  stamps  his  habit  upon  his 
face.  The  beer  drinker  is  usually  bloated  and  shows  a  tendency  to 
put  on  excessive  fat.  He  is  apt  to  appear  stolid,  indifferent  and  men- 
tally inactive. 

Individuals  vary  markedly  in  their  sensitiveness  to  the  action  of 
alcohol,  some  noticing  its  action  or  influence  even  in  minute  quantities. 

1  Kerr,  Norman:    Alcoholism,  Vol.  Ill,  "Twentieth  Century  Practice  of  Medicine,"  1895. 


460  PRACTICAL  HYDROTHERAPY. 

Constant  use  of  such  beverages  begets  in  those  addicted  to  their  use 
a  tolerance  that  is  remarkable.  Different  men  are  affected  in  different 
ways,  some  getting  drunk  or  being  affected  "in  their  legs,"  and  unable 
to  walk,  in  another  the  "tongue  is  loosened,"  and  in  still  another  a 
restless  activity  is  produced.  Harnack,  who  has  closely  studied  the 
question  of  small  or  moderate  doses  of  alcohol,  says  that  it  exercises 
simultaneously  a  stimulating  action  upon  certain  functions  and  a  de- 
pressing action  upon  others,  and  this  fact  should  never  be  lost  sight  of. 
Those  who  have  such  nervous  systems  as  are  very  sensitive  should 
not  be  taken  as  a  measure  of  tolerance,  nor  should  they  be  made  the 
standard  for  a  universal  law  for  the  governing  of  mankind. 

It  has  often  been  asserted  that  the  medical  man  prescribing  alco- 
hol has  been  a  chief  factor  in  the  promotion  of  drunkenness.  This 
subject  has  been  specifically  studied  by  Norman  Kerr,  who  secured 
careful  records  of  over  three  thousand  cases  of  alcoholism,  and  he 
states  that  he  was  unable  to  trace  initiation  of  the  alcoholism  to  the 
medical  prescription  in  more  than  one-half  of  1  per  cent,  of  cases, 
this  being  practically  a  negligible  quantity.  The  author's  experience 
corresponds  with  that  of  Kerr,  and  it  should  be  noted  in  passing  that 
in  this  respect  there  is  a  wide  range  of  difference  between  alcoholism 
and  drug  addictions.  In  like  manner  another  investigation  of  sta- 
tistics and  a  personal  experience  leads  to  the  almost  certain  conclu- 
sion that  the  use  of  tobacco  does  not  predispose  to  the  use  of  alcohol 
per  se,  but  that  the  indulgence  of  alcohol  and  tobacco  are  usually 
associated  together,  especially  by  those  who  indulge  in  convivial  drink- 
ing. So  many  human  beings  use  tobacco  with  or  without  the  use  of 
alcohol  that  it  seems  to  the  author  that  little  difficulty  is  experienced 
in  settling  the  question  that  tobacco  use  does  not  tend  to  produce 
alcoholism. 

The  physiological  action  of  alcohol  is  coextensive  with  the  physio- 
logical processes  of  the  human  body,  and  requires  study  in  detail 
rather  than  in  generalization  of  action.  Entering  as  alcohol  does  in 
a  more  or  less  diluted  form,  the  first  impression  upon  the  mouth  is 
to  cause  a  feeling  of  warmth,  followed  by  an  increase  in  the  flow  of 
saliva  due  to  the  local  irritation  of  the  nerve  terminations  within  the 
buccal  cavity.  This  influence  is  likewise  experienced  by  the  esopha- 
gus, and  on  finally  reaching  the  stomach  the  sensation  of  warmth 
becomes  noticeably  present,  and  where  not  too  concentrated  produces 
a  sense  of  agreeable  heat.  Upon  the  mouth  and  gums  the  continued 
use  of  alcohol  produces  an  intense  redness  or  congestion,  especially 
noticeable  upon  the  fauces  and  gums,  tending  to  make  them  the  sub- 
ject of  so-called  catarrhal  inflammations.  The  tongue  soon  becomes 
covered  with  a  thick  heavy  coating  composed  of  the  debris  of  epi- 
thelial cells,  and  this,  together  with  its  general  action  upon  the  gastro- 
intestinal tract,  produces  a  peculiarly  offensive,  sour  breath,  that  is 


ALCOHOLISM.  461 

easily  recognized  by  the  initiated.  This  doubtless  has  something  to 
do  with  and  assies  in  causing  the  habitue  to  lose  his  appetite.  The 
tongue  has  its  characteristic  tremor,  hereafter  mentioned.  The  huccal 
conditions  are  well  known  and  classically  described  in  the  story  of 
the  day  as  of  a  "dark  brown  taste." 

The  first  impression  upon  the  secretion  of  the  stomach  is  an  in- 
creased   flow   of   gastric    juice,   accompanied   by   a   dilatation    in   the 
blood-vessels  of  the  stomach  wall  and  mucosa.     As  soon  as  the  first 
shock  passes  away  absorption  begins  to  take  place,  and  alcohol  enters 
the  circulation  and  is  thereby  carried  to  all  the  tissues.     Until  lately 
it  has  been  held  that  small  doses  of  alcohol  produce  an  insignificant 
effect   upon   the   pepsin    and    hydrochloric   acid   of   the   gastric   juice, 
while  large  closes  act  as  an  irritant  to  the  stomach  walls  and  inhibit 
the  secretion  of  gastric  juice.     This  can  no  longer  be  maintained,  for 
the  experiments   of  Kellogg2  have  conclusively  shown  that  even  so 
much  as  0.5  per  cent,  of  alcohol  will  inhibit  secretion  and  interfere 
with    the    food-dissolving   and    digestive    power   of    this    juice,    while 
larger  quantities  not  only  inhibit,  but  destroy  its  value.     Following  the 
inhibition  of  gastric  juice,  it  is  not  surprising  to  find  the  general  nutri- 
tion of  the  patient  soon  impaired.     Alcohol  being  an  irritant  narcotic 
paralysant,  we  would  naturally  expect  large  quantities,  continued  for 
any  length  of  time,  to  cause  sufficient  irritation  to  set  up  an  inflam- 
mation of  the  mucous  membrane,  with  loss  of  the  secreting  power  of 
the  stomach,  associated  with  an  excessive  secretion  of  thick,  tenacious 
and  adherent  mucus.     Its  local  action  is  somewhat  lessened  by  being 
taken  well  diluted  with  water,  for  it  is  a  rule  that  the  greater  the  con- 
centration the  greater  the  irritation ;  but  the  author's  observation  has 
taught   him  that   whether  taken   in   diluted   form  or  not,   sooner  or 
later,    merely   a   question   of   time,    the   pathological    changes    can   be 
easily  found.     It  may  be  confidently  stated  that  alcohol  in  any  form  is 
a  noxious  poison  to  the  gastric  mucosa,  so  that  the  old  idea  of  cer- 
tain forms  of  alcoholic  indulgence  being  productive  of  no  trouble  is 
a  delusion  that  is  fast  fading  before  the  laboratory  and  physiological 
experiments  that  have  demonstrated  beyond  the  question  of  a  doubt 
its  true  action.     Where   alcohol   is  continuously  drunk  these  organs 
and   tissues   become   alcoholically   upset    with    increasing    frequency, 
and   it  is  then  that  we  begin  to  get  not  alone   functional  disorders, 
but  actual  pathological  changes.     Even  small  doses  of  alcohol  taken 
at  meals  have  a  deleterious  influence  because  of  their  inhibitive  action, 
and   it  may  be  here  stated   for  those  who  wish  to   follow  the  plain 
teachings   of  truth  and  honesty  that   alcohol  need  never  and  should 
not  be  administered  to  those  who  suffer   from  so-called  "indigestion 
or   dyspepsia."      After   a   continuous   use   of   spirits,   atrophy   of   the 

2  Kellogg,    J.    H.:    "Physiological    Action    of    Alcohol,"    Modern    Medicine,    November    and 
December,    1905. 


462  PRACTICAL  HYDROTHERAPY. 

glandular  cells  takes  place,  usually  following  a  chronic  glandular  gas- 
tritis. As  a  result  of  this,  appetite  and  relish  for  food  is  soon  lost. 
The  connective  tissue  is  greatly  increased,  and  in  some  instances 
fatty  degeneration  takes  place.  Where  much  malt  liquors  are  drunk 
we  are  apt  to  find  (this  is  especially  true  of  the  German,  latterly  the 
American  peoples)  dilatation,  the  result  of  weakened  muscular  fiber. 
This  dilatation  is  superimposed  upon  the  irritation,  inflammation  and 
digestive  disturbances  due  to  the  action  of  the  alcohol  itself.  The 
intestines  become  subject  to  two  influences  where  alcohol  is  continu- 
ously drunk,  the  first  resulting  from  the  action  of  the  absorbed  alco- 
hol circulating  in  the  vascular  system,  and  the  other  the  action  of  the 
alcohol  and  imperfectly  digested  food  upon  the  intestinal  mucosa  itself. 
Intestinal  disturbances  are  particularly  prominent  in  children  who 
use  alcoholic  stimulants,  and  upon  the  adult  we  find  the  same  atonic 
state  present  in  the  intestine  as  is  found  in  the  stomach.  The  alco- 
holic suffers  from  most  obstinate  and  chronic  constipation,  and  this 
in  its  turn  adds  to  the  circulating  blood  large  quantities  of  toxic  ma- 
terial that  aid  the  alcohol  in  producing  structural  changes  in  the  body 
generally.  Its  action  upon  the  liver  is  most  pernicious,  being  mani- 
fold. Alcohol,  absorbed  by  the  radicals  of  the  portal  vein,  is  carried 
directly  with  but  little  modification  into  the  hepatic  structures,  thick- 
ening the  biliary  secretion  and  lessening  it  in  quantity.  The  terminal 
result  of  this,  constant  bathing  of  the  liver  with  an  alcoholically  poi- 
soned stream  is  one  of  the  various  forms  of  interstitial  hepatitis, 
or  what  is  commonly  known  as  cirrhotic  or  "hob-nail  liver.*'  Indi- 
viduals have  most  peculiar  capacities  for  resisting  these  active  tissue 
changes  in  the  liver  as  well  as  the  general  system,  some  seeming  anom- 
alies having  come  under  my  personal  observation.  The  influence  of 
alcohol  upon  the  pancreas  and  pancreatic  digestion  is  interference 
with  the  fat-splitting  and  emulsifying  action  of  this  secretion,  for 
alcohol  once  brought  in  contact  with  pancreatic  fluid  coagulates  or 
precipitates  the  juice  and  renders  the  enzymes  inactive  and  valueless. 
This  is  usually  assigned  as  the  reason  for  the  presence  of  fatty  de- 
generation in  the  heart  and  other  organs,  generally  encountered  in 
autopsies,  but  does  not  altogether  explain  fatty  degeneration ;  the 
author  is  constrained  to  believe  that  some  of  the  degeneration  is  due 
to  improper  oxidative  effects  within  the  system. 

In  recent  years  our  knowledge  of  the  physiological  action  of  alco- 
hol upon  the  heart  and  blood-vessels  has  undergone  a  complete  and 
radical  change,  since  measures  of  precision  have  been  introduced  by 
means  of  which  its  effect  upon  these  organs  could  be  accurately  esti- 
mated, and  in  no  field  does  physiological  action  appear  more  de- 
ceptive. The  action  of  alcohol  upon  the  heart  and  circulation  is  not 
that  of  a  stimulant,  but  a  depressant.  This  fact  can  be  clearly  brought 
out    by    those    who    will    undertake    a    series    of    tests    with    any 


ALCOHOLISM.  463 

blood  pressure  instrument.  Janeway3  calls  attention  to  the  fact,  and 
the  author  has  repeatedly  proven  it  to  be  true  with  the  sphygmo- 
manometer, that  alcohol  is  not  a  stimulant  to  the  heart  or  circula- 
tion, but,  on  the  contrary,  in  an  average  or  considerable  dose,  the 
arterial  pressure  falls  instead  of  being  raised,  the  fall  ranging  any- 
where from  fifteen  to  twenty  millimeters.  In  like  manner  the  tonom- 
eter, which  measures  the  actual  force  of  the  heart,  shows  that  the 
force  of  this  organ  is  actually  reduced,  Cushney  claiming  it  to  be 
due  to  the  weakening  of  both  the  vasoconstrictor  centers  and  the 
heart  itself,  and  further  states  that  animal  experiments  have  con- 
firmed this  view.  It  therefore  stands  to  reason  that  the  apparently 
large  and  bounding  pulse  is  not  the  result  of  increased  heart  energy 
and  vigor,  but  simply  an  indication  of  a  relaxed  and  dilated  state  of 
the  small  vessels  of  the  peripheral  circulation.  The  influence  of  alco- 
hol upon  the  blood-vessels  is  direct  and  powerful.  The  immediate 
effect  is  to  dilate  enormously,  and  to  relax  the  entire  arterial  system, 
especially  the  medium,  small-sized  and  capillary  blood-vessels.  This 
action  is  largely  brought  about  by  its  action  upon  the  vasoconstrictor 
nerves,  acting  in  conjunction  with  the  excitor  nerves  of  the  heart, 
lessening  the  resistance  to  the  flow  of  blood  and  heart  action.  The 
dilatation  is  supplemented  by  the  influence  of  alcohol  upon  the  mus- 
cular fibers  of  the  blood-vessels  themselves,  as  it  is  a  paralysant, 
thus  increasing  its  influence  upon  the  vasomotor  centers.  It  must 
be  borne  in  mind  that  it  is  not  only  necessary  to  have  a  relaxation 
of  the  peripheral  blood-vessels  to  relieve  the  burden  of  the  heart. 
but  it  is  esential  that  with  the  dilatation  of  the  vascular  system  the 
activity  and  energy  of  the  heart  must  be  increased.  This  is  not  ac- 
complished in  the  case  of  alcohol,  for  this  poison  weakens  the  action 
of  the  structual  centers  as  well  as  the  nerve  ganglia  which  are  situ- 
ated in  and  initiate  and  maintain  the  activity  of  the  heart  itself. 
Were  this  deleterious  action  of  the  poison  upon  the  circulation  all, 
it  would  not  be  so  bad,  but  it  must  be  recalled  that  the  heart  is  aided 
in  its  propelling  influence  by  the  rhythmical  action  of  the  small  arte- 
ries and  capillaries  which  push  the  blood  onward  into  the  veins.  The 
presence  of  alcohol  circulating  within  the  vascular  system  paralyzes 
this  action  coiheidently  with  the  production  of  dilatation.  As  a  result 
there  is  an  accumulation  in  and  a  slowed  movement  of  the  blood  in 
the  entire  venous  system.  This  slowing  and  accumulation  of  blood 
has  a  tendency  to  "dam"  the  arterial  blood  and  gradually  increase 
the  obstruction  and  load  that  has  to  be  pushed  through  the  veins  to 
the  right  side  of  the  heart.  This  increase  of  pressure  or  tension 
within  the  veins  frequently  tends  to  produce  dilatation  of  the  right 
side  of  a  heart  whose  cardiac  muscular  fiber  is  already  weakened. 
That  the  venous  system  is  engorged  and  the  resistance  increased  is 

3  Janeway,  T.   C:   "Clinical  Study  of  Blood  Pressure,"  1904,  p.  223. 


464  PRACTICAL  HYDROTHERAPY. 

a  matter  of  common  observation,  the  skin  becoming  bluish  and  the 
veins  prominent.  The  irritation  of  alcohol  upon  the  neural  mechan- 
ism of  the  heart  and  blood-vessels  results  in  its  reserve  power  being 
called  upon ;  in  this  way  cardiac  debilitation  is  increased.  It  is,  then, 
not  surprising  that  we  find  "heart  failure"  a  common  occurrence  in 
drunkards,  cardiac  dilatation  being  so  frequently  present.  Post-mor- 
tem observations  have  shown  that  the  heart  is,  as  a  rule,  fattily  de- 
generated, and  in  many  cases  covered  in  whole  or  in  part  with  fatty 
tissue.  The  muscular  fiber  is  pale  and  flabby,  the  cavities  dilated 
and  containing  clots.  Myocarditis  and  endocarditis  are  frequently 
present.  The  blood-vessels  themselves  present  enlargement  with 
atheromatous  degeneration,  this  latter  being  followed  by  a  marked 
fibrosis  and  brittleness  characteristic  of  arterial  sclerosis.  As  a  re- 
sult of  these  changes  the  normal  elasticity  of  the  blood-vessels  is  lost, 
and  they  take  on  an  increased  rigidity  that  should  make  us  careful 
and  cautions  in  the  administration  of  drugs,  especia1ly  strychnine  and 
atropine,  which  raise  the  blood  pressure  to  such  a  great  extent. 

The  blood  is  the  circulating  medium  by  which  the  tissues  are  re- 
constructed, waste  material  removed  therefrom,  and  vital  action  main- 
tained, i!"  is  interesting  to  note  here  that  through  phagocytosis  bac- 
terial diseases  are  prevented  and  recovery  from  them  assured.  It 
is  by  these  leucocytes  that  we  expect  the  body  to  be  defended  against 
the  invading  host.  Sims  Woodhead4  has  called  attention  to  a  most 
interesting  fact,  th&.t,  whereas  animals  have  been  rendered  immune 
against  various  bacterial  maladies — in  other  words,  been  vaccinated — 
this  immunity  is  broken  down  and  the  animal  rendered  susceptible 
to  the  action  of  disease  germs  through  the  administration  of  alcohol. 
All  observers  agree  that  alcohol  exercises  a  destructive  and  paralyzing 
influence  upon  protoplasm,  and  tends  to  cause  a  cessation  of  the  ac- 
tivity and  movements  of  the  white  blood  corpuscles.  This  explains 
the  slow  reparative  action  of  the  tissues  and  the  increased  liability 
to  suppuration  so  commonly  observed  in  the  drunkard.  All  scratches 
and  cuts  heal  slowly  and  with  difficulty.  With  the  lessened  activity 
of  the  white  blood  cells,  bacterial  life  increases  and  overwhelms  the 
organism  through  their  pathogenic  action.  Upon  the  red  blood  cells 
alcohol  has  a  most  pernicious  influence,  tending  to  dissolve  out  of  the 
cell  the  loosely  retained  and  combined  hemoglobin,  as  a  result  of 
which  the  blood  cells  shrink  and  possess  greatly  diminished  oxidative 
capacity.  The  failure  of  the  red  cell  to  carry  into  the  general  sys- 
tem the  necessary  oxygen  for  the  proper  processes  of  metabolism 
results  in  a  failure  of  oxygenation  and  the  retention  within  the  sys- 
tem and  bk-od  of  carbon  dioxide.  This  is  but  one  of  the  many  influ- 
ences of  alcohol  by  which  the  entire  system  is  affected  and  the  nutri- 
tional balance  disturbed,  but  it  does  not  stop  here,   for  albuminous 

4  Woodhead,  Sims:  Journal  of  Inebriety,  Autumn,  1907. 


ALCOHOLISM.  465 

elements  carried  within  the  blood  are  apt  to  be  coagulated,  and  the 
waste  products  that  have  entered  the  system  through  the  defective 
digestion  and  improper  hepatic  action  are  not  removed  by  the  natural 
channels,  as  a  net  result  of  which  we  have  the  blood  loaded  with 
impure  waste  products,  the  retention  of  which  renders  this  fluid  less 
powerful  in  construction  and  reconstruction  of  sound  tissue.  As  a 
natural  corollary  to  this,  the  depreciated  toxic  and  devitalized  blood 
fails  to  remove  from  the  tissues  themselves  the  accumulated  waste 
material,  the  result  of  tissue  action.  This  arraignment  of  the  action 
of  alcohol  upon  such  a  vital  and  necessary  tissue  as  the  blood  should 
of  itself  be  sufficient  to  impress  upon  the  medical  man  the  necessity 
of  its  avoidance. 

The  physiological  action  of  alcohol  upon  the  muscular  system  is 
now  pretty  well  established,  and  it  may  be  briefly  stated  that  muscular 
strength  is  actually  diminished  under  the  influence  of  even  moderate 
doses  of  alcohol,  facts  that  have  been  demonstrated  by  Kellogg  and 
Furer.5  The  advocates  of  alcohol  have  frequently  pointed  out  that 
alcohol  acts  as  a  tonic  and  stimulant  to  those  fatigued,  citing  the  fact 
that  when  a  person  is  fatigued  and  a  drink  of  alcohol  is  given,  relief 
from  the  fatigue  is  experienced,  and  for  that  reason  it  is  beneficial. 
There  is  no  more  deceptive  belief  held  than  this.  As  an  actual  fact, 
the  person  is  not  relieved  by  the  action  of  alcohol  upon  the  muscular 
system  because  he  is  stimulated  or  thereby  rested,  or  because  his  mus- 
cles have  become  reinforced  through  the  tonic  influence  of  alcohol, 
but  simply  because  he  cannot  feel  the  sense  of  fatigue.  In  other  words, 
the  nerves  governing  the  sense  of  fatigue  have  become  benumbed 
and  so  paralyzed  that  the  individual  is  unaware  of  and  does  not  ap- 
preciate the  fact  that  he  is  fatigued  and  weakened.  Subjective  feel- 
ing is  a  most  uncertain  and  unscientific  method  upon  which  to  base 
assertions,  but  it  can  be  truly  and  accurately  gauged  where  the  dyna- 
mometer is  used,  this  showing  accurately  the  decreased  muscular  ca- 
pacity. Prof.  Parks,  experimenting  in  the  last  Ashantee  war,  and  the  ex- 
periences of  Arctic  explorers,  hunters,  and  many  carefully  conducted  ex- 
periments upon  laborers  and  athletes,  show  that  their  muscular  activity 
is  weakened  by  the  use  of  alcohol.  It  is  interesting  to  note  that  when 
the  Great  Western  Railway  decided  to  change  the  gauge  of  its  rails 
along  the  whole  line,  it  substituted  oatmeal  gruel  for  alcohol,  because 
the  work  required  accuracy  and  had  to  be  done  with  great  rapidity  and 
with  unusual  energy.  The  author  has  heard  Prof.  Nansen  personally 
state  that  Arctic  explorers  were  always  weakened  by  the  use  of  alco- 
hol, and  that  it  was  banished  from  his  expeditions.  That  alcohol 
affects  the  muscles  detrimentally  is  shown  plainly  in  the  chronic 
drinker.  If  the  tongue  is  protruded  it  will  be  noticed,  even  in  the 
earlier  stages  of  alcoholism,  that  it  trembles,  and  that  as  the  malady 

xxxi 
S  "Rational  Hydrotherapy,"  1906. 


466  PRACTICAL  HYDROTHERAPY. 

progresses  this  increases,  and  added  to  it  is  a  general  tiemor  or  shaking 
of  the  muscles  which  at  times  may  simulate  shaking  palsy.  In  addi- 
tion, we  may  find  fibrillary  twitchings  that  may  be  and  are  sugges- 
tive of  paresis.  Many  drunkards  are  afflicted  with  a  certain  muscular 
irritability  and  restlessness,  which  is  most  often  manifested  in  the 
early  morning  on  awakening,  probably  due  to  the  fact  that  they  have 
had  no  alcohol  during  the  night  to  act  as  a  sedative  and  narcotic, 
and  are  experiencing  the  toxic  effects  of  its  absence  This  trembling 
is  oftentimes  most  noticeable  in  the  legs,  though  after  a  time  it  in- 
volves ail  the  skeletal  muscles. 

The  physiological  action  of  alcohol  upon  the  liidneys  and  urine 
is  a  noticeable  feature  in  nearly  every  case.  It  is  the  function  of  the 
kidneys  to  largely  maintain  the  purity  of  the  blood  by  removing 
therefrom  the  toxic  materials  that  are  taken  into  the  circulating 
stream  from  the  viscera  and  tissues.  This  function  iQ  so  important 
that  where  renal  activity  is  interfered  with  for  even  a  short  time, 
say  a  few  hours,  sufficient  toxic  material  may  be  accumulated  to 
render  the  person  unconscious  and  produce  death  The  primary 
action  of  plcohol  within  the  kidney,  and  brought  to  it  by  the  circu- 
lating blood,  is  that  of  congestion  followed  by  irritation.  If 
we  examine  the  urine  at  this  time  we  are  apt  to  find  the  quantity 
augmented,  a  faint  trace  of  albumin ;  urea,  phosphates,  chlorides  and 
sulphates  diminished.  Indican  is  frequently  present  together  with 
other  evidences  of  intestinal  putrefactive  changes.  Microscopically, 
we  find  uric  acid  and  oxalate  of  calcium  crystals  much  in  excess  of 
that  found  in  health;  some  epithelium,  a  few  casts  and  cylindroids, 
a  result  either  of  the  changed  metabolism  of  the  tissues  or  an  altera- 
tion by  alcohol  of  the  relative  solubility  of  the  urine  salts.  The  casts 
and  cylindroids  result  from  irritation.  Alcohol  is  cumulative  in  its 
action,  and  it  is  not  long  before  the  drunkard  is  apt  to  have  nephritis, 
the  natural  sequence  of  the  irritation  of  the  kidney  tissue,  with  the 
result  that  the  function  of  these  important  organs  is  interfered  with 
in  a  marked  degree  and  permanently  crippled.  Where  the  injury  is 
continued  the  kidney  begins  to  undergo  those  changes  that  are  char- 
acterized as  cirrhotic.  We  get  the  small,  hard,  shrunken  kidney. 
The  interstitial  tissue  is  increased  and  the  parenchyma  compressed 
and  destroyed.  The  urine  now  presents  characteristic  features — 
large  in  quantity,  pale  in  color,  low  specific  gravity,  diminished  solids, 
trace  of  albumin,  microscopically  a  few  epithelial  cells  and  an  occa- 
sional hyaline  cast. 

The  physiological  action  of  alcohol  upon  the  lungs  is  to  lower 
their  activity  and  interfere  with  their  function.  Through  its  influ- 
ence upon  innervation  and  by  weakening  the  muscular  structures 
of  the  chest  walls,  inspiration  is  lessened  in  its  amplitude,  and  as  a 
result  less  air  enters  the  chest.     The  normal  diffusion  of  gases  that 


.ILCOHOLISM.  467 

should  take  place  in  these  organs  is  thereby  lessened,  and  the  failure 
to  thoroughly  and  completely  oxygenate  the  blood  results  in  a  failure 
of  these  organs  to  remove  from  the  blood  itself  tha  contained  carbon 
dioxide,  increasing  the  presence  of  waste  material  and  gases  in  the 
system,  reinforcing  the  failure  of  the  kidney  to  do  its  work.  Chronic 
alcohol! -m  lends  to  produce  a  low-grade,  chronic  congestive  state  of 
the  mucous  membrane  of  the  bronchioles  and  air  cells,  by  which  their 
vitality  is  lowered  and  the  individual  rendered  much  more  liable 
to  an  infection  by  any  of  the  many  forms  of  micro-organisms.  Those 
who  have  given  the  subject  considerable  attention  find  it  an  experience 
too  common  to  remark  upon  that  the  chronic  alcoholic  is  a  predis- 
posed subject  for  the  manifestations  of  acute  and  chronic  tuberculo- 
sis, and  that  if  we  wish  to  offer  an  efficient  and  powerful  prophylactic 
measure  for  the  prevention  of  consumption  it  would  be  the  repression 
of  alcoholism.  It  is  not  an  unusual  thing  for  pulmonary  tuberculosis 
be  one  of  the  complications  of  the  terminal  stage  of  chronic  alco- 
holism. 

The  physiological  action  of  alcohol  upon  the  temperature  is  most 
interesting  The  average  unscientific  mind,  and  especially  laymen, 
insist  that  the  temperature  of  the  body  and  its  warmth  is  actually 
increased.  As  has  been  said  before,  alcohol  is  a  most  deceptive  poison 
when  judged  by  ''feelings."  In  spite  of  the  simp'icity  of  a  test  to 
guard  agamst  such  a  fallacy  as  believing  that  alcohol  raises  the  tem- 
perature and  increases  the  warmth  of  the  body,  physicians  seem  to 
be  averse  to  testing  this  fact  with  their  clinical  thermometers.  It 
may  be  sU.ted  that  a  characteristic  effect  of  alcohol  is  its  lowering 
of  the  temperature  of  the  human  body  and  thereby  depriving  it  of 
heat,  one  of  the  most  necessary  essentials  to  the  maintenance  of  health 
and  vitality.  Owing  to  its  action  upon  the  peripheral  blood-vessels, 
a  marked  dilatation  takes  place,  with  an  increased  quantity  of  blood 
circulating  therein,  with  increasing  heat  radiation.  Upon  heat  forma- 
tion alcohol  lessens  its  amount  by  direct  toxic  action  of  the  poison 
on  the  thermogenetic  centers,  incidentally  by  lessening  muscular 
activity  and  decreasing  metabolism  and  oxygenation.  The  main  loss, 
however,  is  by  radiation,  assisted  by  diminished  oxidation.  The 
thermometer  will  show  a  nearly  constant  subno"mal  temperature. 
This  is  another  reason  why  deer-stalkers,  Canadian  hunters,  Arctic 
explorers  and  others  have  given  up  its  use. 

The  physiological  action  of  alcohol  upon  metabolism  has  already 
been  touched  upon,  though  this  phase  of  alcoholism  has  not  been  in- 
vestigated as  it  should  be.  The  normal  and  active  oxidation  that  takes 
place  in  healthy  tissues  is  interfered  with  by  the  presence  of  alcohol, 
preventing  as  it  does  tissue  change,  removal  of  waste  products  and 
reparation.  The  failure  of  the  blood  to  absorb  the  needed  amount 
of   oxygen   prevents   the   final   intercellular   processes   of   metabolism 


468  PRACTICAL  HYDROTHERAPY. 

taking  place  in  the  tissues,  and  waste  accumulates  within  the  system. 
The  failure  of  the  kidney  to  remove  from  the  blood  the  toxic  ma- 
terial absorbed  from  the  gastro-intestinal  tract  aid  from  the  toxic 
tissues,  adds  to  the  already  poisonous  condition,  and  further  prevents 
the  removal  of  the  results  of  tissue  oxidation.  The  processes  of 
metabolism  are  so  intricate,  complex  and  varied  that  it  may  truly  be 
stated  that  each  and  every  organ  in  the  body  influences  its  action,  and 
it  is  not  surprising  that  alcohol,  which  affects  directly  and  indirectly 
every  tissue  and  function  of  the  body,  should  seriously  derange  these 
changes.  It  must  be  borne  in  mind,  and  may  be  reiterated,  that,  aside 
from  all  the  influences  here  referred  to,  it  has  its  own  destructive 
and  paralyzing  action.  Sims  Woodhead6  has  clearlv  demonstrated 
that  alcohol  produces  changes  in  metabolism  closely  allied  to  those 
produced  by  the  toxins  of  various  bacterial  poisons.  He  states  that 
oxidation,  which  is  the  essential  element  in  all  metabolism,  is  most 
seriously  interfered  with  by  this  poison.  This  essential  feature  has 
been  elaborated  by  Sajous.7 

The  physiological  action  of  alcohol  upon  the  skin  and  mucous 
■membranes  is  easily  observed.  The  first  effect  is  that  of  a  rather 
diffuse  ledness,  most  noticeable  in  the  face,  due,  as  we  have  seen,  to 
a  dilatation  of  the  blood-vessels,  and  accompanied  by  a  moderate 
degree  of  perspiration.  Where  this  is  repeated  the  vasomotor  paresis 
becomes  constant,  and  we  get  the  facies  generally  associated  with 
alcoholism,  consisting  of  the  watery,  blood-shot  eyes,  yellowish  hue  of 
the  skin,  bloated  appearance  of  the  face,  and  an  enlargement  of  the 
veins  upon  the  nose  and  cheeks.  So  common  and  prominent  is  the 
nasal  feature  that  it  has  been  dubbed  by  the  laity  as  the  "bottle  nose." 
After  long  and  continuous  use  the  skin  assumes  a  yellowish,  grayish 
tinge,  is  usually  bathed  in  a  cold,  clammy,  disagreeable  sweat,  es- 
pecially unpleasant  to  the  touch.  By  some  alcohol  is  used  to  cover 
sores  and  wounds  in  primitive  conditions  and  practice.  Its  action  is 
to  promptly  coagulate  the  albumin  of  the  tissues,  forming  a  thin,  pro- 
tective, air-excluding  layer  which  promotes  healing.  Alcohol  in  the 
shape  of  an  "alcohol  rub"  produces  a  sense  of  coolness,  due  to  its 
rapid  evaporation,  and  where  this  is  prevented  and  alcohol  is  kept  in 
prolonged  contact  with  the  skin  it  excites  a  sense  of  heat  and  super- 
ficial inflammation.  Where  confined  it  penetrates  the  tissues,  but 
when  "rubbed  in"  its  influence  is  superficial.  Its  action  upon  the 
mucous  membranes  is  similar  but  more  intense.  On  account  of  the 
features  here  enumerated  alcohol  has  been  used  as  a  domestic  gargle 
in  various  inflammations  of 'the  mouth  and  throat,  and  the  author  can 
state  from  his  own  experience  that  it  seems  to  possess  excellent  value 
where  the  mucous  membrane  is  denuded.     In  the  buccal  and  pharny- 

6  Ibidem. 

7  Sajous:   "Internal  Secretions,"  1907. 


ALCOHOLISM.  469 

geal  inflammation  and  soies  that  accompany  syphilitic  affections  of 
the  mouth  and  throat,  when  used  as  a  gargle,  through  its  power  to 
coagulate  albumin,  has  brought  about  healing  when  other  better  known 
remedies  have  failed. 

The  physiological  action  of  alcohol  upon  the  nervous  system  is,  in 
the  opinion  of  the  author,  the  most  pernicious  of  all  its  baneful  effects. 
Poets  have  pictured,  moralists  described,  pathologists  determined  and 
neurologists  observed  its  peculiar  influence.  Alcoholism  is  one  of  the 
most  frequent  causes  of  mono-  and  multiple  neuritis.  No  neurologist 
of  any  experience  but  what  knows  the  many  and  varied  forms,  simple 
and  complex,  from  a  neuritis  of  a  single  unimportant  nerve  to  Korsa- 
koff's symotom-complex,  more  frequently  owe  their  origin  to  liquor 
than  any  other  cause.  Alcohol,  as  has  heretofore  been  shown,  has  a 
most  benumbing  influence  upon  the  peripheral  nerves,  actually  lessen- 
ing sensation  in  all  of  its  forms,  this  being  especially  noticeable  along 
the  lines  of  touch,  pain  and  the  temperature  sense.  Where  this  action 
is  continued  the  peripheral  nerves,  following  the  law  applicable  to 
other  tissues,  become  inflamed,  and  as  a  result  partial  or  complete 
degeneration  may  take  place.  Its  action  upon  the  vasomotor  nerves 
has  already  been  noted,  the  paralysis  of  which  causes  dilatation  of 
the  blood-vessels  located  in  the  cutaneous  area.  The  sense  of  touch 
and  pain  is  so  blunted  by  the  presence  of  alcoholically  saturated  tissues 
that  normal  perception  is  not  only  often  misconstrued,  but  even  not 
perceived.  This  has  often  been  utilized  for  minor  surgical  work. 
The  blunting  of  the  nerves  of  temperature  is  such  that  while  the 
individual  has  the  sensation  of  warmth  in  the  skin  actual  thermometric 
tests  show  the  temperature  to  be  subnormal.  Any  one  who  will  under- 
take to  carry  out  these  simple  experiments  can  demonstrate  to  his 
satisfaction  the  truth  of  the  assertions  made  here.  It  is  a  common 
statement  lhat  drunkards  fall  and  do  not  hurt  themselves,  but  this 
may  reasonably  be  called  in  question  wdien  one  stops  to  consider  the 
fact  that  they  may  be  hurt,  but  because  of  the  anesthesia  present  they 
elo  not  notice  the  injury.  Probably  this  belief  has  been  enhanced  by 
the  fact  that  in  the  falls  of  drunkards  fewer  bones  are  broken,  this 
being  easily  accounted  for  by  the  relaxed  and  unresisting  muscular 
system.  Many  of  the  so-called  functional  disorders  associated  with 
the  peripheral  nerves  are  in  reality,  in  alcoholics,  forms  of  subacute 
or  chronic  inflammation,  and  are  usually  revealed  by  careful  and 
thorough  lesting.  The  neuritides  of  alcoholism  are  less  frequently 
recovered  *rom  than  the  same  class  of  diseases  that  originate  from 
other  causes.  This  is  probably  to  be  explained  through  the  lessened 
vitality  and  vitiated  state  of  the  system.  The  knee-jerks  and  reflexes 
are  exaggerated.  Upon  the  central  nervous  system  alcohol  exhibits 
its  profoundest  influence.  The  brain  and  spinal  cord  are,  of  all  the 
tissues  of  the  human  body,  the  most  delicate  and  highly  organized, 


470  PRACTICAL  HYDROTHERAPY. 

and  are  of  all  the  tissues  the  most  promptly  responsive  to,  and  most 
constantly  affected  hy,  alcohol  circulating  in  the  blood.  Upon  these 
tissues  its  action  is  subtle  and  far-reaching,  sparing  no  function  or 
attribute  of  the  mind,  its  action  being  intensified  through  the  special 
affinity  that  alcohol  has  for  nerve  elements.  Its  action  is  directly  toxic 
and  involves  all  mentalization.  In  addition  to  this,  it  superadds  the 
burden  of  a  toxic  blood  stream  loaded  with  retained  waste  products 
of  urea,  ammonia  and  carbon  dioxide,  re-enforcirg  its  own  action. 
It  is  inieresling  to  note  that  alcohol  antedates  senility  by  from  five  to 
twenty  years,  and  this  takes  place  even  in  those  who  have  no  alcoholic 
heredity.  People  of  unstable  nervous  organizations  are  peculiarly 
susceptible  to  its  influence,  and  are  apt  to  acquire  the  habit  readily. 
It  would  probably  pass  unchallenged  to  say  that  alcohol  has  been  the 
most  prolific  inciter  of  breaches  of  human  and  divine  law.  ranging 
from  the  smallest  offense  to  the  greatest  crimes  in  the  calendar,  both 
against  person  and  property.  The  beneficent  result  of  modern  scien- 
tific research  has  placed  beyond  the  question  of  a  doubt  the  fact  that 
a  large  proportion  of  the  most  confirmed  alcoholics  and  inebriates 
are  dieased.  and  that  they  are  so  thoroughly  diseased  that  they  may 
even  have  an  utter  loathing  against  intoxicants,  and  yet  use  alcohol  in 
spite  of  their  repeated  and  desperate  struggles  to  avoid  drink.  One 
would  feel  gratified  if  they  could  believe  that  intelligent  laymen  and 
scientists  were  united  in  realizing  that  the  question  of  alcoholism  is 
not  one  of  mere  morality,  vice  or  crime,  to  be  punished  by  jail  or 
penitentiary  sentence,  by  excommunication  or  treatment  as  though 
they  were  wantons,  but  deserves  careful  consideration,  intelligent 
thought,  medical  supervision  and  confinement.  The  nervous  and 
sanguine  individual  is  much  more  susceptible  to  the  influence  of  alcohol 
than  his  phlegmatic  brother. 

Immediately  upon  taking  a  drink  of  liquor  there  is  a  sense  of  well- 
being,  comfort  and  rcstfulness,  alcohol  resembling  thus  in  its  action 
other  narcotics.  Those  of  us  who  have  seen  many  cases  of  the 
different  forms  of  Habitual  ion  will  at  once  draw  the  analog}'  between 
this  action  of  alcohol  and  the  "hypo"  of  the  morphinist.  This  period 
of  well-being  is  due  to  a  paralysis  of  the  vasomotor  nerves  of  the 
blood-vessels  of  the  meninges,  which  become  dilated  with  an  increased 
quantity  cf  blood;  exhilaration  and  elation  ensue  Venous  stasis 
follows ;  the  blood-vessels  cannot  contract  and  fresh  aerated  blood 
does  not  reach  the  brain.  This  period  is  succeeded  by  one  of  de- 
pression, with  a  sense  of  weariness  that  calls  for  another  drink.  To 
the  average  layman  and  non-medical  person  an  intoxicated  individual 
occupies  the  whole  samut  of  emotions  from  pity  and  sorrow  to  humor 
and  laughter,  for  he  appears  to  be  simply  a  man  who  has  gone  beyond 
his  own  control  and  more  or  less  bereft  of  reason  nnd  judgment,  but 
the  intelligent  scientist  and  thinker  looks  deeper  than  the  surface  and 


ALCOHOLISM.  471 

realizes  the  fact  that  he  is  under  the  pathologic  influence  of  an  anes- 
thetic that  is  destroying  his  body  and  soul.  The  confirmed  alcoholic 
and  the  inebriate  may  have  a  knowledge  of  their  present  and  past 
state,  and  may  be  alive  to  each  downward  step  as  they  plunge  into  the 
abyss,  and  may  even  form  the  strongest  resolutions  to  drink  no  more, 
yet  with  all  this,  and  in  spite  of  the  most  desperate  attempts  to  abstain, 
may  be  utierly  powerless  to  refrain  from  intoxication.  This  should 
be  borne  in  mind,  as  it  is  the  basic  rock  upon  which  State  prophylaxis 
of  alcoholism  is  to  oe  built. 

It  may  not  be  amiss  to  call  attention  to  the  tissue-crave  from 
which  these  individuals  suffer.  By  its  affinity  for  water,  alcohol  is 
freely  taken  up,  and,  as  we  have  shown,  circulating  through  the  body 
vitiates  and  depresses  the  tissues  to  such  an  extent  that  as  soon  as  the 
anesthetic  effect  of  the  drink  has  disappeared  the  tissues  cry  out  for  a 
fresh  supply,  and  until  this  is  given  the  whole  system  is  in  an  agony  of 
distress,  so  that  even  though  the  patient  may  loathe  ±e  taste  of  liquor 
he  cannot  resist  the  overpowering,  intense  and  uni/ersal  tissue-crave 
for  relief. 

Alcoholics  are  prone  to  have  morbid  ideas  and  delusions,  one  of 
the  most  common  of  which  is  the  delusion  of  marital  infidelity.  Many 
a  wife  has  had  to  suffer  for  this  delusion,  so  frequently  occurring  in 
this  disease,  and  probably  built  upon  the  groundwork  of  a  sexual 
incapacity  resulting  from  the  toxic  and  degenerating  influence  of  the 
poison.  Delusions  of  persecution  are  common,  and  often  occur  be- 
cause of  disorders  of  the  special  senses — noises  ir>  the  ears,  muscac 
z'olitantcs,  the  appearance  of  figures,  lines  or  flying  forms  that  weirdly 
float  before  the  eyes.  These  delusions  and  hallucinations  cause  the 
individual  to  harbor  the  idea  that  some  one  is  trying  to  injure  him, 
or  that  he  is  hunted  by  a  ghost  or  other  intangible  "things."  Alcoholics 
are  morbidly  jealous,  especially  of  their  marital  partner,  and  of  others 
against  whom  they  have  taken  some  unfounded  dislike.  I  have  fre- 
quently found  them  to  suffer  from  the  morbid  dread  of  impending 
disaster,  a  sword  of  Damocles,  intangible  yet  ever  present,  from  which 
they  cannot  escape. 

Motor  disturbances  are  shown  in  the  fine  tremor,  non-intention, 
which  is  nearly  always  present.  They  lose  control  of  the  muscles  in 
the  execution  of  delicate  movements.  The  gait,  movement  and  speech 
are  inco-ordinate  and  ataxic.  Their  ability  to  measure  the  actual 
strength  of  their  muscular  acts  is  lost,  and  at  times  they  may  strike 
without  the  intention  of  doing  any  harm,  and  yet  hit  so  hard  as  to 
actually  kill. 

Insomnia  is  always  present,  sleep  being  disturbed,  and  from  which 
they  wake  unrefreshed  and  weary.  In  the  earlier  stages  alcohol 
causes  heavy  and  profound  dreamless  sleep,  but  gradually  and  insen- 
sibly it  becomes  less  sound,  is  accompanied  by  harassing  and  horrible 


472  PRACTICAL  HYDROTHERAPY. 

dreams,  from  which  the  sufferer  awakens  terrified.  Insomnia  is  the 
terror  of  the  chronic  drunkard,  especially  those  who  are  cultivated, 
cultured  neurotics,  and  who  demand  sleep  at  the  cost  of  powerful 
influences. 

As  a  cause  of  mental  disease  alcohol  is  most  prolific;  it  is  inter- 
esting to  note  that  just  in  proportion  to  its  use  insanity  increases. 
Kerr8  believes  that  40  to  50  per  cent,  of  all  the  crime  and  bad  conduct 
may  be  ascribed  to  alcohol ;  the  figures  seem  large,  but  in  the  author's 
opinion  are  not  overestimated. 

Alcohol  has  always  been,  and  is  at  the  present  time,  a  most  im- 
portant, if  not  the  "tost  important  factor  in  crime. 

The  physiological  action  of  alcohol  upon  the  sexual  system  is  one 
of  the  mos:  important  and  interesting  of  all  the  actions  of  spirits  upon 
the  organism.  A  careful  anaylsis  of  conditions  will  show  that  its  firs: 
influence  is  purely  mental.  The  ethics  and  relationship  between  the 
sexes  is  like  the  bloom  upon  the  peach — delicate,  beautiful ;  is  main- 
tained through  the  sum  total  of  the  action  of  all  those  influences  for 
good  that  go  to  make  up  honor,  probity,  truth,  conscience  and  respect. 
The  influence  of  alcohol  is  to  first  lower  or  even  obliterate  this  standard 
in  the  individual.  The  direct  action  of  the  poison  upon  the  sexual  sys- 
tem and  its  correlated  nerve  centers  is  to  stimulate  and  increase  desire 
as  control  is  lessened.  It  will  thus  be  seen  that  the  individual  under  the 
influence  of  alcohol  has  lost  that  feature  of  his  mentality  that  would 
tend  to  kerp  him  in  the  straight  and  narrow  path,  while  at  the  same 
time  he  has  over-stimulated  sexuality,  the  repression  of  which  is  abso- 
lutely necessary  for  his  proper  conduct.  This  statement  made  in 
masculine  terminology  is  equally  applicable  in  terms  feminine,  for  it 
is  a  fact  notorious  to  "rounders"  and  fast  men  of  the  world  that  the 
proverbial  bird  and  cold  bottle  are  the  means  by  which  sexual  gratifi- 
cation may  be  obtained  even  though  the  individual  male  or  female, 
would  under  ordinary  circumstances  have  not  so  indulged.  Alcohol 
has  been  the  means  of  the  downfall  of  many  bright  and  promising 
young  men ;  the  ruin  of  many  young  women  whose  lives  would  other- 
wise have  been  all  that  they  should  have  been  and  as  "pure  as  the 
driven  snow."  Moralizing  does  not  belong  to  text-book  writing,  but 
certainly  parents  should  realize  the  dangers  to  which  their  sons  and 
daughters  are  exposed  when  they  gaily  and  thoughtlessly  permit  youth- 
ful individuals  whose  blood  current  is  naturally  strong  and  hearty  to 
indulge  in  a  beverage  whose  insidious  and  subtle  power  is  to  rob  them 
of  what  goes  to  make  some  of  the  most  beaut' fu!  attributes  of 
humanity — modesty  and  purity.  The  unfortunate  trend  of  educa- 
tion and  early  contact  between  the  sexes  in  this  country  has  pre- 
pared mere  boys  and  girls  with  a  knowledge  that  was  unknown  to 
progenitors  half  a  decade  later,  and  this,  together  with  the  increased 

8  Ibidem. 


ALCOHOLISM.  473 

and  recognized  consumpti  m  of  alcohol  by  women,  is  now  accepted  as 
one  of  the  reasons  for  the  great  increase  in  open  and  clandestine  pros- 
titution.  It  is  certainly  a  good  rule  and  an  excellent  law  that  young 
people  should  be  governed  by  all  those  influences  that  go  to  increase 
and  develop  the  resistive  power  of  the  will,  and  should  avoid  all  influ- 
ences, especially  alcohol,  which  will  have  a  tendency  to  lessen  or 
reduce  this  most  necessary  attribute  of  the  brain. 

Between  single  and  married  males  there  is  little  difference  in  the 
amount  of  drinking,  but  in  women  the  difference  between  the  married, 
widowed  or  divorced  and  the  spinster  is  in  the  proportion  of  one  to 
four  or  six.     This  difference  in  the  consumption  of  liquor  by  those 
who  have  entered  the  marital  relation  is  to  be  larg.ly  accounted  for 
in  the  increased  worries  and  care,  trials  and  tribulations  that  come 
to  the  family  as  a  whole.     Those  who  study  the  internal  mechanism 
of  the  home  know  that  even  in  the  "best  regulated  families"  the  essen- 
tial  human   element   is   never   absent,   and   that  unavoidable    friction, 
worry,  cares  between  husband  and  wife,  the  fretting  of  children,  their 
supervision  and  attention,  the  never-ending  and  constant  burden,  all 
tend  to  lead  the  woman  to  seek  in  the  anesthetic  influence  of  alcohol 
some  escape  from  the  incubus  and  millstone  that  is  about  her  neck. 
"Woman's  work  is  never  done,"  saith  the  old  saying,  and  it  is  based 
upon    this    statement    that    the    genesis    of    alcoholism    is    oftentimes 
founded.      A   child   conceived   during  the   alcoholic   period   may   not 
only  have  a  strong  tendency  to  but  may  actually  acquire  drunkenness 
at   an   early  age.     Where   the   mother   is   the   drinker   her   influence 
is  more  powerful  than  the   father's,  but   it   becomes   greatly  accen- 
tuated   when    both   use    the    poison.      Drunkards    beget    neuropaths, 
and  these  neurotics  may  not  drink  or  have  a  drink  craze  themselves, 
may    in    their    turn   beget    progeny   with    an    unstable    neural    organ- 
ization and  a  strong  tendency  to  the  use  of  alcohol.     It  will  thus 
be  seen  that  in  its  effects  it  may  skip  a  generation  and  return   in 
the  next.     These  neurotics  and  degenerates  have  their  vital  and  re- 
sistive force  much  lessened,  so  that  they  show  the  effects  of  alcohol 
more  quickly  than  does  the  child  ot  normal  parentage,  and  my  own 
observations  have  been  that  such  progeny  are  much  more  apt  to  have 
delirium  tremens  than  the  ordinary  drinker. 

Alcohol  does  not  stop  at  changing  the  function  of  the  nervous 
system,  but  eventuates  in  organic  disease.  These  changes  gradually 
take  place,  and  in  the  terminal  stages  we  find  that  the  brain  and  nervous 
system  are  seriously  affected.  The  membranes  are  thickened  and 
altered;  the  blood-vessels  are  greatly  thickened,  the  blood  supply  is 
lessened,  Lhe  brain  anemic  and  poorly  nourished.  The  brain  itself 
is  shrunken,  with  flattened,  narrow  convolutions.  There  is  an  effusion 
of  serous  fluid  in  the  subarachnoid  and  ventricular  spaces.  A  general 
wasting  of  the  neuron  bodies  and  fibers,  followed  r>y  a  dense  growth 


474  PRACTICAL  HYDROTHERAPY. 

of  matty  connective  tissue,  takes  place,  which  intrudes,  presses  upon 
and  alters  Their  form,  impoverishes  their  nutritional  supply  and  lessens 
their  functional  capacity.  It  is  not  surprising,  therefore,  with  the 
degeneration  of  the  nerve  and  the  subsequent  growth  of  fibrous  tissue, 
that  mental  symptoms  may  be  traceable  to  the  degeneration  of  brain 
tissue  itself  as  a  result  of  alcoholic  poisoning.  It  is  at  first  a  func- 
tional, late;  an  organic,  physical  destruction  and  degradation  of  both 
meningeal  and  cerebral  tissues. 

As  a  predisposing  cause  of  other  diseases,  alcohol  is  most  prolific. 
It  weakens  the  power  of  the  organism,  lowering  its  opsonic  index  so 
as  to  lessen  resistance  to  the  various  infectious  diseases,  death  re- 
sulting oftentimes  in  very  short  periods  from  recoverable  diseases, 
this  being  especially  true  of  pneumonia.  The  alcoholic's  tissues  are 
much  more  subject  to  pus  formation  or  any  form  of  streptococcic 
infection,  and,  in  fact,  the  alcoholic  is  in  reality  more  subiect  to  every 
phase  and  form  of  disease  than  the  temperate  man.  The  converse  is 
true,  that  in  no  inconsiderable  number  of  cases  certain  diseases  pre- 
dispose the  individual  to  alcoholism,  among  which  may  be  prominently 
mentioned  syphilis,  consumption,  many  neuroses,  diabetes,  sunstroke, 
apoplexy,  rmd  head  injuries.  In  women  nervous  shocks,  menstruation, 
especially  v.- here  it  is  painful,  the  menopause,  and  vvhere  their  life  is 
monotonously  dull,  lead  to  the  use  of  liquor.  In  this  connection  it 
may  be  remarked  that  many  instances  of  alcoholism  in  men,  but  more 
particularly  in  women  and  children,  are  due  to  the  patent  medicine 
habit?  Talent  medicines  are,  as  a  rule,  a  mere  "shallow  device"  for 
placing  within  the  grasp  of  these  unfortunates  an  alcohol  "dope"  by 
means  of  which  "repeaters"  are  made  and  alcoholic  and  narcotic  habits 
formed.  It  is  a  business  the  villainy  of  which  could  not  be  compassed 
in  an  anathema,  where  every  word  in  the  English  language  of  such  a 
character  employed,  and  men  who  sell  their  souls  in  such  a  business 
for  the  monetary  returns  should  all  suffer  like  Macbeth,  with  a  million 
Banquo's  ghosts  in  daily  and  nightly  attendance,  for  "all  the  sweets  of 
Arabia  cannot  wash  the  stain  from  off  their  hands." 

Many  of  those  who  engage  in  the  sale  of  alcohol,  or  who  "tend 
bar,"  while  they  do  not,  as  a  rule,  diink  to  excess  and  get  drunk,  are 
fairly  good  consumers  of  their  own  beverages.  Drivers,  cabmen  and 
others  who  are  more  or  less  in  the  open  air  are  apt  to  consume  large 
quantities  of  alcohol.  Its  influence  upon  them  seems  to  be  somewhat 
less  pernicious  than  those  who  lead  an  indoor  life,  for  the  fresh  air 
and  exercise  seem  as  it  were  to  "burn  up"  a  large  part  of  the  alcohol 
drunk.  Many  men  who  are  employed  in  callings  involving  responsi- 
bilities, anxiety  and  exhausting  brain  work,  and  even  in  some  of  the 
learned  professions,  we  find  frequently  drifting  into  the  use  of  alcohol 

9  See  series   of  articles  in   Collier's  Weekly,   Ladies'   Home   Journal   and   Journal   of   the 
American  Medical  Association  during  1907. 


ALCOHOLISM.  475 

to  overcome  some  of  the  depressing,  wearing  influences  of  their  work 
upon  the  nervous  system.  It  has  been  my  personal  experience  that  of 
all  professions  the  ministry  indulges  less  in  alcohol  than  any  other, 
and  this  is  as  it  should  be,  owing  to  the  fact  that,  by  their  teaching, 
example  and  moral  influences,  they  must  be  against  the  use,  by  them- 
selves and  in  others,  of  alcoholic  beverages. 

It  is  generally  accepted  that  the  two  races,  the  Anglo-Saxon  and 
the  Russ,  :n  the  consumption  of  alcohol  show  probably  the  greatest 
proportion  per  population.     From  personal  obsenation  in  America, 
England  and  upon  the  Continent,  the  author  believes  it  to  be  true  that 
the  Latin  nations  are  by  far  the  more  temperate.     In  Spain,  Italy  and 
France,  to  national  habits  and  customs,  the  use  of  the  vin  du  pays,  with 
its  minimum  amount  of  alcohol,  and  the  fact  that  'treating"  is,  as  a 
rule,  unknown,  is  to  be  ascribed  some  of  the  reasons   for  the  tem- 
perate use  of  this  poison.     Savage  races  are  prone  to  indulge  excess- 
ively in  the  use  of  alcohol,  owing  to  their  intense  and  characteristic 
energy,  the  nearest  approach  to  which  is  in  this  country  the  negro 
race.    '  The   author   has   had   unusual   opportunity  of    observing  the 
growth  of  alcoholism  and  other  narcotic  drug  habits  among  negroes, 
and   can   s'ate   from  positive  knowledge  that  there  was  at  one  time 
comparatively  small  consumption  of  spirits  or  whisky;  that  in  later 
years  beers  and  lighter  drinks  have  given  way  to  the  use  of  the  stronger 
beverages ;  that  the  negro  race  at  the  present  time  is  more  readily  ex- 
cited to  drunkenness,  and  it  may  be  incidentally  remarked  that  they  are 
much  more  speedily  killed  by  its  use.     It  is  the  author's  belief  that 
eventually  the  negro  will  be  largely  depopulated  through  the  action  of 
tuberculosis,  liquor  and  syphilis,  the  results  of  which  are  shown  with 
startling  and  shocking  vividness  in  their  effects  upon  the  descendants 
of  Ham.     It  is  certainly  a  commentary  worthy  to  be  emulated  that 
the  Jew,  by  his  peculiar  inhibition  and  rational  control,  shows  a  marked 
freedom  from  the  effect  and  action  of  alcohol.    It  is  the  author's  belief, 
however,  iliat  this  will  gradually  pass  away   for  ihe  reasons  before 
assigned,  their  intermarriage   with   other  races,   and  because  of  the 
peculiar  strenuous  life  in  which  they  are  now  being  thrown. 

Atmospheric  and  climatic  conditions  influence  many  persons  in 
the  use  cc  liquor.  A  depressing,  dark,  cold,  damp,  foggy  climate, 
by  its  action  upon  the  higher  nervous  centers  and  the  circulation,  tends 
to  create  in  many  individuals  a  desire  to  do  away  with  this  depression 
and  restore  the  seeming  balance;  this  they  accomplish  by  the  use 
of  alcoholic  spirits.  Climate  increases  the  consumption  of  spirits  in 
those  whose  will-power  has  become  weakened,  and  offers  an  excuse 
for  an  indulgence.  It  is  probably  for  climatic  reasons  that  the  Anglo- 
Saxon  and  the  Russian  become  the  greatest  inducers  m  alcoholic 
beverages.  American  authors— and  with  whom  I  heartily  agree— 
believe  that  the  increased  nerve  tension,  as  well  as  the  rapid  vana- 


476  PRACTICAL  HYDROTHERAPY. 

tions  in  temperature,  in  this  country,  largely  account  for  the  greater 
intensity  and  rapidity  of  American  inebriety  —  the  entire  career  of 
an  inebriate  in  America,  trom  start  to  finish,  being  of  much  shorter 
duration. 

The  presumption  would  seem  to  be  that  the  lower  and  unedu- 
cated classes  would  be  the  greater  users  of  liquor;  still,  my  experi- 
ence thoroughly  agrees  with  that  of  Kerr,10  in  that  8S  to  90  per  cent, 
of  all  tiie  cases  have  received  liberal  education,  translating  the  word 
liberal  into  a  "fair  amount"  of  education.  Many  of  the  "brightest 
lights,"  who  have  had  advantages  of  university  training,  become  subject 
to  the  craze,  for  we  find  in  civilized  and  educated  communities  re- 
fined people  are  much  more  subject  to  alcoholic  habituation  than 
would  be  at  first  believed.  In  the  educated  and  upper  classes  my 
observation  also  leads  me  to  believe  that  the  intoxication  is  more 
maddening  and  boisterous  than  in  the  lower  classes,  in  which  latter 
we  may  expect  the  more  brutal  and  sodden  examples  of  alcohol's 
deadly  work.11 

The  American  nation  has  been  accused  of  being  driven  to  alcohol 
on  account  of  improper,  defective  and  partly  cooked  food.  Authors, 
in  a  vein  of  badinage,  have  stated  that  the  skillet  and  frying-pan 
have  been  two  of  the  implements  by  means  of  which  Americans 
have  achieved  proficiency  in  the  use  of  liquor.  There  is  no  question 
but  what  a  number  of  persons  are  led  to  use  liquor  through  indi- 
gestion and  other  ills  flowing  from  bad  and  improper  food,  under 
the  mistaken  idea  that  alcohol  stimulates  digestion,  a  condition,  as 
we  have  already  noted,  that  is  opposed  to  fact. 

The  immediate  exciting  causes  that  lead  to  alcohol  are  unlimited, 
but  the  principal  ones  may  be  stated.  It  may  start  as  a  temporary 
measure  and  become  permanent,  the  individual  thus  gradually  and 
imperceptibly  growing  into  the  habit.  Mental  distress,  where  it  orig- 
inates in  domestic,  commercial  or  religious  life,  is  a  fruitful  cause 
of  consumption  of  this  poison.  There  is  an  urgent  and  incessant  de- 
mand for  an  euthanasia  that  can  only  be  bought  by  some  narcotic 
poison.  In  like  manner  loss  of  reputation  and  marital  disparities 
tend  to  the  use  of  that  which  will  give  oblivion  in  the  present,  but 
that  means  disgrace  and  death  in  the  future.  Many  men — and  this 
is  especially  true  of  physicians  and  lawyers — take  to  alcohol  as  a 
temporary  means  of  "tiding  them  over"  some  period  of  special  stress. 
Having  found  comfort  in  the  benumbing  influence  of  alcohol,  they 
are  prone  to  turn  to  it  again  and  again,  until  the  habit  becomes  fully 
established  and  they  are  compelled  to  continue  its  use  to  maintain  the 
equilibrium.  The  excitation  of  puberty,  the  menopause,  pregnancy 
and  during  the  menstrual  period ;  the  monotonous  and  dull  routine, 

10  Ibidem. 

11  Ibidem 


ALCOHOLISM.  477 

marital  Infelicity  and  excesses,  a  longing  and  a  desire  to  forget  all 
that  may  make  life  uncomfortable  and  unhappy,  lead  many  women  tc 
the  cup  that  cheers  and  destroys.  Insomnia,  pain  and  ill-health  drive 
many  to  liquor,  and  in  this  connection  the  advertisements  of  certain 
"malt"  whiskies  as  beneficial  in  these  conditions  have,  to  the  author's 
certain  knowledge,  created  not  only  physical  havoc  with  women,  but 
have  made  unsuspecting  though  moderate  drinkers  of  not  a  few.  It 
is  to  be  regretted  that  all  those  that  belong  to  this  class  are  unaware 
of  the  value  of  tonic  hydrotherapy. 

The  pathological  anatomy  has  been  dealt  with  when  consider- 
ing the  physical  action  of  alcohol  upon  the  various  organs  and  tissues, 
but  it  may  he  stated  in  general  terms  that  the  fibrous  structures  of 
the  body  are  especially  subject  to  stimulation  and  inordinate  growth, 
this  being  markedly  accentuated  in  the  blood-vessels,  liver,  kidney 
and  brain.  This  increase  is  so  profound  as  to  be  macroscopically 
visible,  and  constitutes  a  structural  and  functional  disorganization 
of  such  extent  and  intensity  as  to  justify  the  words  of  Sieveking, 
that  "there  is  not  a  degenerative  bodily  condition,  which  may  not 
result  from  alcohol."  This  is  not  all,  however ;  the  texture  of  various 
organs  becomes  riddled  with  fatty  degeneration,  their  structure  and 
function  so  weakened  as  to  materially  interfere  with  the  performance 
of  their  duties. 

Acute  Alcoholic  Intoxication. 

Acute  alcoholic  intoxication  is  the  most  common  of  all  the  acute 
processes,  and  most  frequently  arises  from  the  use  of  ethylic  liquor. 
No  man  sits  down  to  get  drunk,  but  after  a  few  drinks  and  the  alcohol 
has  begun  to  enter  the  circulation  the  vascular  relaxation  heretofore 
spoken  of  takes  place,  followed  by  its  characteristic  sense  of  glow 
and  warmth,  together  with  pleasurable  ideation.  He  begins  to  become 
lively,  merry — nay,  joyous — and  with  an  increased  feeling  of  excite- 
ment and  energy.  In  the  highest  spirits,  he  becomes  communicative, 
and  often  confides  to  strangers  his  most  private  affairs,  that  he  would 
never  think  of  talking  about  were  he  really  himself.  Gradually  the 
action  of  alcohol  increases  this  tendency,  his  spirits  and  excitement 
rising  higher  and  higher,  until  he  becomes  more  demonstrative  in  love 
and  argument,  more  emphatic  in  his  gestures,  louder  and  coarser  in 
his  laughter,  more  furious  in  his  fun  and  jokes.  With  deeper  pota- 
tions he  begins  to  develop  an  obstinacy  that  is  incapable  of  being 
reasoned  with,  and  that  is  not  amenable  to  control.  He  gradually 
grows  incoherent  in  thought  and  actions,  his  speech  becomes  thicker 
and  more  confused,  his  imagination  excited,  his  emotions  dominating 
him  completely.  Intellect,  reason,  will-power,  thought  and  conscience 
gradually  recede,  fade  in  the  background,  and  in  many  instances  a 
modest,  retiring,  quiet  individual  becomes  a  boaster,  a  braggart  and  a 


478  PRACTICAL  HYDROTHERAPY. 

liar.  This  has  been  denominated  "Dutch  courage."  About  this  period 
many  drunkards  become  irritable  and  quarrelsome,  the  meek  and 
lowly  often  violent.  By  this  time  the  muscular  system  has  become 
seriously  affected,  there  is  difficulty  in  co-ordinating  arms  and  legs ;  he 
staggers,  reels  and  trembles.  When  this  is  continued  much  further 
he  becomes,  in  the  language  of  the  police  station,  "dead  drunk" — 
lying  upon  the  floor,  on  the  pavement,  even  in  the  gutter,  uncon- 
scious of  his  surroundings,  pale  of  face,  cold  of  extremities,  insensible, 
"dead  to  the  world,"  with  all  gone  that  goes  to  make  the  glory  of  man 
above  the  beasts,  with  neither  sensation,  perception,  emotion  nor 
mental  power.  The  heart  and  circulation  keep  him  from  passing  to 
that  bourne  from  which  no  traveler  has  returned,  and  enable  him  to 
emerge  from  the  dark  stupor  into  which  he  has  plunged.  It  is  an 
observation  that  is  constantly  presented  to  the  physician  that  the  man 
or  woman  who  has  a  paroxysm  of  acute  intoxication  for  a  day  or  two 
and  then  allows  a  month  or  several  months  to  intervene,  does  really 
less  injury  to  the  body  than  those  who  take  even  small  doses  of  alcohol 
daily  or  several  times  a  day.  The  total  abstinence  period  enables  the 
organs  and  tissues,  as  it  were,  to  throw  off  the  pernicious  influence  of 
the  poison,  and  in  this  way  he  can  for  years  withstand  his  bouts  or 
sprees.  As  we  shall  note  later  on,  the  dangerous  drunkard  is  the 
moderate  drinker,  who  "soaks"  his  system  daily  in  four  or  five  mod- 
erate doses  of  alcohol.  Complete  repair  of  tissue  cannot  take  place 
in  a  few  short  days,  nor  in  a  few  short  weeks,  immediately  succeeding 
a  severe  drinking  bout  or  an  attack  of  alcoholic  delirium.  Every  one 
of  these  attacks  acts  in  a  damaging  way  upon  the  nervous  and  genera! 
tissues,  and  in  order  that  repair  may  be  brought  about  time  becomes 
an  essential  element  to  secure  a  renewal  both  of  tissue  and  function. 

The  pathology  of  acute  alcoholic  poisoning  depends  upon  the  kind 
of  drunkard — the  voluntary  occurring  as  an  accident  during  drinking 
from  custom,  habit  or  fashion ;  the  involuntary,  the  inebriate,  drinking 
because  of  the  strong  morbid  impulse  and  crave ;  an  acute  intoxica- 
tion being  merely  an  incident  in  his  drinking  career. 

The  prognosis  is  excellent ;  in  private  practice  the  writer  has  so  far 
never  lost  a  case.  In  general  and  public  hospital  practice,  however, 
the  prognosis  is  very  much  less  favorable,  owing  to  the  fact  that  the 
parties  brought  in  are  more  or  less  in  an  unfavorable  general  state 
of  health,  or  have  been  picked  up  on  the  street  in  a  state  of  coma 
after  having  been  exposed  for  some  time  to  climatic  influences,  es- 
pecially dangerous  being  those  of  winter,  and  in  which  the  condition 
is  followed  by  an  attack  of  pneumonia. 

The  treatment  of  acute  alcoholic  poisoning  should  be  to  immedi- 
ately empty  the  stomach.  If  this  has  not  been  accomplished  by  emesis 
on  the  part  of  the  patient,  the  stomach-tube  is  to  be  introduced  and 
lavage  practiced.     Before  the  stomach-tube  is  removed  a  tumblerful 


ALCOHOLISM.  479 

of  hot  water  containing  thirty  grains  of  the  chloride  of  ammonia 
should  be  passed  into  the  stomach.  The  bowel  is  then  moved  by  means 
of  a  high  hot  saline  enema.  The  patient  should  now  he  catheterized, 
and  it  will  he  frequently  found  that  the  urine  is  loaded  with  albumin, 
urea,  blood  casts  and  epithelium,  a  condition  which,  if  allowed  to  go 
on,  would  result  in  uremic  coma  and  death.  These  cases  must  be 
promptly  treated  by  catharsis,  diuresis  and  diaphoresis.  The  general 
treatment  here  outlined  will  in  the  majority  of  instances  meet  the 
indications.  It  has  been  the  author's  experience  that  if  any  one 
element  is  essential  to  the  success  in  treatment  it  is  the  application  of 
heat  and  keeping  the  patient  warm.  For  this  purpose  he  is  removed 
to  the  hot  full  bath,  in  which  he  is  thoroughly  rubbed  by  the  attendant, 
and  at  the  same  time  his  head  and  face  are  sponged  with  cold  water. 
A  cool  turban  is  then  placed  upon  his  head  and  he  is  allowed  to  remain 
in  the  bath  at  a  temperature  of  100°  to  104°  to  110°  F.,  if  possible, 
for  eight  to  ten  minutes.  From  this  he  is  removed  and  wrapped  in 
the  full  dry  pack,  continuing  the  use  of  the  cool  turban  or  the  ice-water 
helmet.  This  treatment  will  stimulate  and  in  many  instances  do  away 
entirely  with  the  depression  and  exhaustion  found.  It  is  a  good  plan 
to  use  every  three  hours  during  the  first  twenty-four  one  to  two 
drachms  of  aromatic  spirits  of  ammonia,  well  diluted  with  water.  If 
the  patient  is  very  restless  we  may  at  the  same  time  administer  hypo- 
dermically  small  doses  (one-thirtieth  to  one-twentieth  grain)  of 
apomorphia  hydrochlorate.  After  the  patient  has  been  removed  to 
bed  external  heat  should  be  carefully  applied,  especially  to  the  feet 
and  abdomen,  it  being  a  good  plan  to  keep  hot-water  bottles  in  the 
bed  about  him.  The  diet  must  be  absolutely  liquid,  and  consist  of 
warm  milk,  milk  and  Vichy  water,  or  hot  milk  and  lime-water,  and 
as  soon  as  possible,  if  the  stomach  will  retain  same,  pill  of  blue  mass 
(three  to  seven  grains)  or  calomel  (two  to  five  grains)  administered. 
When  there  is  evidence  of  reaction  it  is  well  to  commence  with  the 
cold  sponge  carefully  performed.  When  he  responds  to  this  we  may 
proceed  to  the  use  of  the  full  wet  pack  at  75°  to  65°  F.  for  twenty 
to  thirty  minutes.  The  success  that  the  author  has  attained  in  the 
use  of  this  method,  which  can  be  applied  at  any  general  hospital, 
private  home,  jail  or  infirmary,  is  such  as  to  make  him  lean  upon  it 
with  a  feeling  of  certainty  in  the  management  of  these  cases.  He 
is  firmly  of  the  opinion  that  the  proper  place  for  the  treatment  of 
drunkards  picked  up  on  the  street  by  the  police  is  not  the  ward  of 
the  jail,  but  a  general  hospital,  properly  equipped  in  order  that  the 
method  here  outlined  may  be  applied. 

The  after-treatment  of  acute  alcoholic  intoxication  is  a  matter 
that  is  somewhat  difficult,  as  these  patients  are  prone  at  the  end  of 
two  or  three  days  to  desire  again  to  take  up  their  avocation  or  resume 
the  even  tenor  of  their  way.     It  should  be  impressed  upon  their  minds, 


480  PRACTICAL  HYDROTHERAPY. 

however,  that  it  is  essential  for  them  to  undergo  a  course  of  treatment 
for  at  least  thirty  days  in  order  to  do  away  with  the  evil  effects  of 
the  drinking  bout.  This  treatment  should  embrace  a  liberal  dietary, 
with  a  restriction  of  the  amount  of  meat  eaten  and  the  daily  use  of 
the  hot-air  bath  or  electric  light  bath  until  profuse  perspiration  takes 
place,  followed  by  the  horizontal  rain  bath  at  100°  F.  for  one  minute, 
reduced  to  70°  F.  for  one-fourth  minute,  pressure  twenty  pounds. 
The  temperature  of  this  bath  should  be  rapidly  dropped  to  65°  F. 
and  the  pressure  increased  to  thirty  pounds.  As  soon  as  the  patient 
can  stand  its  application,  which  is  usually  at  the  end  of  about  a  week, 
the  cold  jet  douche,  pressure  thirty  pounds,  should  be  used  as  a 
finishing  treatment  to  the  above,  applied  for  five  to  ten  seconds  up 
and  down  the  spine.  Where  access  cannot  be  had  to  such  an  insti- 
tution where  hydrotherapy  is  used,  the  general  hospital  or  private 
home  may  employ  the  general  wet  pack  at  65°  F.  for  thirty  to  sixty 
minutes,  followed  by  the  ablution  or  sponge  at  60°  F.,  or  the  half 
bath  for  three  minutes  at  65°  F.  These  latter  methods  are  in  no 
way  comparable  to  the  use  of  the  circular  rain  bath  and  jet  douche. 
It  is  simply  astounding  at  times  to  see  the  beneficial  results  that  follow 
this  treatment  after  the  ordinary  alcoholic  spree.  The  keeping  of  the 
patient  under  treatment  for  thirty  days  enables  the  physician  to  exert 
a  strong  moral  influence  that  will  oftentimes  obtain  from  him  a  real 
desire  to  turn  from  the  error  of  his  ways.  This  element  in  the  treat- 
ment is  unquestionably  a  neglected  one,  and  should  have  the  attention 
of  the  medical  fraternity  much  more  often  in  the  future  than  it  has 
in  the  past. 

Acute  Alcoholic  Delirium;  Delirium  Tremens. 

This  is  an  acute  alcoholic  toxemia  characterized  by  trembling, 
dreadful  fright  and  great  prostration.  It  occurs  chiefly  in  habitual 
drinkers,  although  it  occasionally  attacks  a  drinker  after  a  single  bout. 
Some  persons  seem  to  be  especially  liable  to  these  attacks,  owing  to 
the  peculiar  action  of  alcoholic  beverages  upon  their  nervous  system, 
the  poison  probably  having  a  selective  influence.  Delirium  tremens  is 
so  well  recognized  as  a  positive  and  frequent  outcome  of  alcoholic 
indulgence  that  it  is  made  the  subject  of  jokes  upon  the  stage,  and  is 
a  condition  that  is  readily  and  promptly  recognized  by  the  layman. 

Usually  the  patient  who  is  about  to  have  an  attack  of  delirium 
tremens  manifests  a  restlessness  both  day  and  night,  is  irritable, 
peevish  and  easily  upset.  He  has  generally  gone  for  quite  a  while, 
sometimes  many  days,  with  little  appetite,  digestive  disturbances  and 
practically  eaten  no  food — in  fact,  it  may  be  considered  a  "starvation 
delirium."  At  other  times  the  attack  is  more  sudden  in  onset,  and 
the  patient  is  seized  without  premonitory  warning;  in  fact,  some  cases 
may  retire  at  night  and  awake  either  during  the  night  or  early  morning 


ALCOHOLISM.  >^1 

in  a  fully  developed  attack.  Delirium  is  usually  the  first  symptom, 
and  is  accompanied  by  a  general  trembling  or  shaking,  this  being  such 
a  prominent  symptom  as  to  cause  former  writers  to  make  it  a  part  of 
the  name  designating  the  disease.  The  sufferer  is  absolutely  stricken 
and  consumed  with  a  deadly  fear,  the  like  of  which  can  only  be  appre- 
ciated by  those  who  have  seen  sufferers  from  this  disease.  He 
becomes  a  prey  to  the  most  loathsome,  gigantic  and  terrible  reptiles, 
which  seem  to  crawl  over  and  about  him  and  sink  their  fangs  into  his 
body.  His  countenance  assumes  a  peculiar  facies  of  terror  that  is 
characteristic.  He  may  believe  that  people  are  after  him  for  the 
commission  of  some  dreadful  crime;  at  other  times  an  indefinite,  un- 
settled, impalpable  something  hangs  above  him  like  "the  sword  of 
Damocles."  At  other  times  rats,  mice,  rabbits,  dogs,  terrible  mon- 
sters, "little  iron  men,"  and  others  seem  to  vie  with  one  another  in 
their  power  and  capacity  to  hurt  and  injure.  These  hallucinations 
may  be  in  almost  any  form,  but  no  matter  which  particular  individua' 
condition  may  be  present,  the  essential  element  is  the  intense  terror, 
the  hallucination  causing  the  patient  to  make  most  fearful  and  strenu- 
ous efforts  to  escape  from  his  tormentors,  oftentimes  clutching  vainly 
and  despairingly  in  his  distress  and  hopelessness.  His  delirium  is  a 
busy  one,  full  of  suspicion  of  each  and  every  thing,  of  every  body. 
He  is  constantly  muttering  or  talking  to  himself  in  an  uncontrollable, 
incoherent  and  incessant  manner,  day  and  night.  In  fact,  some  cases 
rehearse  nearly  all  they  have  done  and  said  in  their  ordinary  vocation 
for  several  days  prior  to  the  attack  of  drinking.  The  temperature  may 
not  rise  over  100°  F.,  at  other  times  it  is  much  higher  than  this,  al- 
though it  rarely  goes,  in  my  experience,  over  104°  F.  The  tempera- 
ture bears  a  somewhat  prognostic  relation  to  the  attack,  for  it  may 
be  stated  that  the  lower  the  temperature  the  better  the  prognosis, 
everything  else  being  equal.  The  pulse  is  fast,  feeble,  soft  and  easily 
compressed.  It  is  usually  a  small  pulse,  and  may  be  intermittent. 
In  the  few  cases  in  which  I  have  been  able  to  test  the  blood  pressure 
I  have  found  it  was  low,  ranging  from  90  to  110  mm.12  The  tongue 
is  tremulous,  indented,  and  covered  with  a  whitish  coat.  The  tremor 
or  trembling  is  usually  well  marked,  and  may  be  both  coarse  and  even 
fibrillary  in  character.  One  of  the  most  marked  and  persistent 
symptoms  of  the  disease  is  insomnia,  which  is  constantly  present  in 
every  case,  and  it  has  been  the  author's  experience  that  where  sleep 
is  promptly  secured  the  patient  begins  at  once  to  gain  strength  and  is 
soon  "out  of  the  woods."  The  skin  is  usually  bathed  in  perspiration 
of  a  cold,  clammy  character,  most  marked  upon  the  extremities,  es- 
pecially the  legs.  This  perspiration  has  a  peculiar — one  might  almost 
say  characteristic — odor,  that  is  very  offensive.  It  is  of  an  acid, 
penetrating  kind,  and  very  much  resembles  the  odor  of  the  chronic 

12  Using  Riva-Rocci  instrument,  broad  band. 

xxxii 


482  PRACTICAL  HYDROTHERAPY. 

alcoholic.  The  digestion  is  very  weak,  the  sufferer  usually  having 
gone  for  quite  a  time  without  eating  anything.  It  is  the  author's  belief 
that  had  the  drinker  taken  food  freely  during  his  bout  the  chances  are 
that  he  would  have  avoided  a  terminal  stage  of  delirium  tremens. 
It  is  not  to  be  expected,  however,  that  an  individual  under  the  in- 
fluence of  a  toxic  agent  that  robs  him  of  judgment  would  likely 
utilize  any  mental  attribute  to  protect  himself  against  a  terminal 
stage,  when  it  is  with  difficulty  that  he  protects  himself  at  all.  It  is 
difficult  to  utilize  mentality  when  one  has  been  robbed  of  it.  It  should 
be  noted  here  that  there  is  usually  present  marked  constipation,  and 
that  the  entire  intestinal  tract  is  in  a  state  of  intense  toxemia.  Where 
the  disease  runs  an  unfavorable  course  and  does  not  subside  in  from 
two  to  five  days  we  usually  find  that  the  pulse  becomes  more  frequent 
and  feeble,  thin  and  thready,  the  tongue  brown  and  parched,  the  de- 
lirium deepens,  there  is  subsultus  tendinum  and  picking  at  the  bed- 
clothes, followed  usually  by  death  from  exhaustion.  This  stage  may 
be  interrupted  occasionally  by  severe  paroxysms. 

The  prognosis  of  acute  alcoholic  delirium  depends  somewhat  upon 
its  degree  as  well  as  upon  the  general  vital  and  resistive  powers  of  the 
patient.  Where  we  have  to  deal  with  those  cases  which  manifest 
symptoms  of  nervous  agitation,  unrest,  tremor  and  apprehensiveness, 
who  partially  recognize  their  condition,  a  good  prognosis  can  be  given, 
provided  absolute  control  of  the  patient  is  obtained.  In  those  cases 
that  might  be  denominated  "frank"  delirium  tremens,  in  which  the 
characteristic  busy  delirium  with  delusions  and  hallucinations  of  fear, 
tremor,  insomnia  and  temperature  under  101°  F.,  we  may  expect  the 
disease  under  treatment  to  disappear  in  from  three  to  seven  days, 
with  a  convalescent  period  of  about  the  same  length  of  time.  Those 
cases  that  are  weak  and  wasted,  whose  temperature  is  high  and  de- 
lirium intense,  present  a  grave  problem.  All  cases  are  unfavorably 
influenced  in  the  prognosis  by  the  fact  that  previous  attacks  have 
taken  place,  by  the  extent  of  the  continuous  drinking  between  the 
attacks,  by  the  presence  of  concurrent  diseases,  especially  if  these  are 
organic  in  character.  Among  those  diseases  that  influence  seriously 
the  prognosis  may  be  mentioned  fatty  degeneration  of  the  heart, 
various  forms  of  kidney  disease,  cirrhosis  of  the  liver,  etc.  It  may 
be  stated  in  passing,  however,  that  the  author  has  seen  in  hospital 
practice  some  cases  recover  in  which  common  sense  would  dictate  a 
speedy  and  fatal  issue,  and  it  is  his  belief  that  only  10  per  cent,  of 
these  cases  die,  even  though  so  many  of  them  are  handicapped  by 
organic  changes  and  by  concurrent  disease  likely  to  produce  death. 

The  diagnosis  of  delirium  tremens,  the  "D.  T.'s,"  presents  little 
difficulty;  in  fact,  the  layman  oftentimes  makes  the  diagnosis  before 
the  physician  is  called,  and,  recognizing  the  seriousness  of  the  con- 
dition, sends   for  the  medical  adviser.     Acute  alcoholic  delirium  can 


ALCOHOLISM.  483 

be  easily  diagnosed  by  the  hallucinations  and  delusions  of  terror,  by 
the  tremor,  temperature,  pulse  and  the  general  history  or  appearance 
of  the  alcoholic. 

Treatment. — In  the  treatment  of  these  cases,  especially  in  hos- 
pitals, sanatoriums  and  institutions  for  their  care,  it  should  be  borne 
in  mind  that  in  the  vast  majority  of  cases  we  are  dealing  with  indi- 
viduals who  are  under  the  most  unfavorable  circumstances  and  in- 
fluences, that  their  vitality  is  low,  their  strength  exhausted,  and  that 
we  may  expect  treatment  to  uncover  a  complication  of  organic  or 
concurrent  disease.  This  should  be  borne  in  mind,  as  it  will  make 
the  physician  in  charge  more  careful  and  attentive  to  his  cases  if  he 
realizes  the  gravity  that  nearly  all  of  them  present.  We  occasionally 
see  persons  brought,  or  who  come  to  us  voluntarily,  believing  that 
they  are  on  the  verge  of  or  threatened  with  an  attack  of  delirium, 
and  who  wish  to  take  the  treatment  in  order  that  they  may  avoid  the 
inevitable  consequences  of  their  alcoholic  life.  They  know  that  a 
short  period  longer  means  a  severe  attack,  and  their  idea  is  to  prevent 
same.  Other  cases  we  see  in  the  shaking  stage  of  a  debauch,  and  who, 
while  they  believe  they  are  threatened  with  delirium,  yet  actually  are 
not  bordering  on  an  attack.  The  last  are  those  that  actually  have  the 
fully  developed  attack  in  progress.  The  treatment  in  these  forms  is 
essentially  one  and  the  same,  and  they  have  been  enumerated  simply 
to  accentuate  the  fact  that  the  "borderliner"  needs  the  treatment  as 
badly  as  the  fully  developed  case. 

Three  indications  stand  out  prominently  in  treatment.  It  may  be 
stated  without  fear  of  equivocation  that  where  they  can  be  secured 
the  case  will  terminate  successfully.  These  essentials  are:  The 
maintenance  of  the  patient's  vitality  and  strength,  the  overcoming  of 
the  motor  restlessness  and  mental  agony,  and  the  production  of  sleep. 

Before  taking  up  the  consideration  of  the  treatment  of  these  three 
important  elements  it  is  necessary,  first,  to  consider  the  question  of 
the  continuation  of  the  liquor.  The  author  has  very  definite  and  well- 
settled  beliefs  upon  this  point,  and  as  he  has  never  in  any  case  seen 
liquor  do  a  particle  of  good,  but,  on  the  contrary,  harm,  and  as  this 
coincides  with  good  common  sense  and  scientific  experience,  it  cer- 
tainly is  far  from  rational  to  make  an  exception  in  delirium  tremens 
when  we  would  not  do  so  in  any  other  form  of  poisoning.  Take,  for 
example,  a  patient  suffering  from  arsenical  or  strychnia  poisoning; 
would  it  be  considered  good  judgment  to  give  the  individual  another 
dose  of  arsenic  or  a  hypodermic  of  strychnia?  The  matter  has  always 
presented  itself  to  me  as  a  strict  toxemia ;  that  the  sooner  we  lift  the 
load  from  oft  the  organism,  wash  the  poison  out  of  the  system, 
the  quicker  would  the  patient  react,  the  better  would  be  the  result, 
and  it  is  for  this  reason  that  I  have  never  advised  the  administration 
of  alcohol,  but  have  immediately  removed  the  poison  and  trusted  to 


484  PRACTICAL  HYDROTHERAPY. 

elimination  and  other  methods  of  stimulation  whenever  possible 
Many  writers  speak  of  the  reaction  that  again  follows  the  adminis- 
tration of  alcohol,  and  this  is  undoubtedly  true.  We  do  not  wish  to 
add  any  more  strains  nor  have  any  alcoholic  reactions ;  but  the  true 
explanation  of  why  alcohol  should  not  be  used  is  that  it  is  the  poison 
that  is  causing  the  disease,  and  every  endeavor  should  be  made  to 
eliminate  and  neutralize  rather  than  add  to  the  already  over-toxic 
state.  Xot  only  should  the  sufferer  abstain  from  alcohol  during  the 
treatment  of  the  delirium,  but  it  is  an  essential  necessity  afterward. 

When  a  case  of  delirium  tremens  is  presented  for  care  and  con- 
sideration it  is  my  universal  rule  to  secure  a  specimen  of  the  urine 
for  analysis  and  to  immediately  administer  thirty  grains  of  ammonium 
chloride  or  two  drachms  of  the  aromatic  spirits  of  ammonia,  giving  it 
preferably  in  a  tumbler  of  very  hot  water.  Usually,  where  this  can 
be  gotten  down  the  patient,  its  effect  will  become  apparent  in  fifteen 
to  thirty  minutes  ;  during  the  meantime  the  patient  can  be  taken  to  the 
bath-rooms  and  there  completely  disrobed.  If  possible  he  should  be 
given  five  to  ten — some  authors  even  recommend  twenty — grains  of 
calomel.  There  is  no  objection  even  to  a  larger  dose;  in  fact,  calomel 
(ten  grains),  trional  or  veronal  (twenty  grains),  and  capsicum  (ten 
to  fifteen  minims)  may  be  given  at  a  single  dose.  The  next  step  is  to 
bathe  the  patient's  face  and  neck  with  cold  water  and  place  him  in 
the  full  lict  bath,  commencing  with  a  temperature  of  100°  F.,  rapidly 
raising  this  temperature  to  110°  or  even  115°  F.  for  three  to  five 
minutes.  This  bath  is  of  especial  value  if  collapse  threatens,  being  a 
powerful  nerve  sedative  and  vasomotor  stimulant.  It  always  re- 
quires two  attendants,  and  sometimes  three,  to  successfully  carry  out 
treatment,  owing  to  the  fact  that  manual  restraint  will  be  re- 
quired  to  get  the  patient  in  the  bath,  to  keep  him  in.  and  to  control 
him  for  a  short  time  afterward,  or  until  the  influence  of  the  bath 
and  the  hypnotic  has  become  noticeable.  While  in  this  bath  it  is  a 
gocd  plan  for  two  of  the  attendants  to  rub  him  well  with  the  hands 
while  the  i  ther  supports  and  bathes  his  head  and  face  with  cold 
water.  As  elimination  is  the  all-important  part,  we  should  endeavor 
to  secure  free  perspiration,  but  this  may  be  an  exceedingly  difficult 
matter  where  one  has  to  deal  with  a  pure  case  of  delirium.  The 
ideal  method  of  treating  such  a  case  would  be  to  have  an  electric 
light  bath  so  arranged  that  the  patient  could  be  placed  within  its 
walls,  and  at  the  same  time  the  globes  protected  from  being  broken 
by  a  lattice-work  of  thin  wire.  This  would  allow  to  a  certain  extent 
the  muscular  movements  to  be  untrammeled  and  yet  obtain  the  pow- 
erful sweating  and  eliminative  influence  of  the  bath.  This  ideal 
treatment,  however,  can  rarely  if  ever  be  secured.  During  the  hot 
full  bath  the  patient  is  given  copious  draughts  of  very  hot  water  in 
order  that  free  diaphoresis  may  be  brought  about.     It  is  advantageous 


ALCOHOLISM.  485 

while  the  patient  is  in  the  hot  full  hath  to  give  the  dose  of  trional 
or  veronal  and  tincture  of  capsicum,  so  that  these  drugs  will  be  enter- 
ing the  system  under  favorable  circumstances  and  begin  their  action 
by  the  time  the  patient  is  removed  from  the  tub.  My  experience 
has  been  that  this  treatment  will  usually  quiet  the  patient  to  such 
an  extent  that  he  may  be  removed  from  the  tub,  wrapped  in  a  sheet 
and  blanket  without  making  very  much  objection.  The  incasing 
of  the  patient  in  the  full  dry  pack  continues  the  effect  of  the  hot  full 
bath  and  produces  perspiration. 

The  author  has  never  advised  nor  sanctioned  the  use  of  opium, 
morphine,  chloral  or  hyoscine  at  this  time,  as  he  believes  that  it  is 
simply  an  additional  toxemia  that  lowers  the  vital  energy  and  dimin- 
ishes the  chances  of  the  patient's  recovery. 

Sometimes  the  patient  cannot  be  put  in  the  hot  full  bath ;  we 
may  then  substitute  the  wet  blanket  pack,  which  is  applied  as  fol- 
lows: A  couple  of  woolen  blankets  of  sufficient  size  for  the  pack 
are  placed  upon  the  bed ;  a  blanket  of  a  similar  size  is  then  taken 
and  wrung  dry  out  of  water  at  a  temperature  of  140°  to  160°  F. 
and  spread  upon  the  two  dry  blankets ;  the  patient,  nude,  is  immedi- 
ately placed  upon  the  blanket  and  rapidly  packed  according  to  the 
method  heretofore  described.  This  pack  primarily  acts  in  the  same 
stimulating  manner  as  all  other  heating  applications,  but  as  the 
temperature  subsides  it  becomes  a  sedative  of  considerable  value, 
although  nothing  like  as  effective  as  the  hot  full  bath.  The  patient 
remains  in  this  pack  from  three  to  fifteen  minutes,  depending  upon 
his  condition,  at  the  end  of  which  time  he  may  likewise  be  removed 
and  packed  in  the  dry  blankets  as  heretofore  described  after  the  use 
of  the  hot  full  bath.  The  full  bath  should  always  be  given  the  pref- 
erence. 

Should  there  be  any  tendency  to  collapse  or  weakness,  use  the 
precordial  ice-bag  and  administer  internally  aromatic  spirits  of  am- 
monia in  one-  or  two-drachm  doses.  Never  use  morphine.  Kerr13 
speaks  most  favorably  of  the  liquor  ammonise  acetatis,  frequently 
repeated,  saying:  "One  is  therefore  driven  to  find  a  medicine  which, 
while  operating  as  soon  as  may  be,  to  get  rid  of  the  accumulation  of 
alcohol  in  the  system,  would  not  by  the  depression  of  narcotization 
or  reactionary  excitement  weaken  the  vis  medicatrix,  in  which  latter 
lies  the  cure."  As  soon  as  we  have  quieted  the  patient,  he  may  be 
removed  to  bed,  where  the  attendant  can  watch  him  until  quietly 
asleep.  Fairly  good  restraint  may  be  obtained  by  a  sheet  tied  across 
the  bed.  by  holding  down  the  blanket  covering,  or  by  pressing  down 
on  the  patient  near  or  over  the  knees,  outside  of  the  blankets. 
The  patient  is  thus  allowed,  if  very  restless,  to  exhaust  himself  by 
his  continuous  muscular  efforts.     It  is  not  long,  however,  except  in 

13  Ibidem. 


486  PRACTICAL  HYDROTHERAPY. 

severe  cases,  before  the  patient  becomes  quiet,  and  sleep  is  here  his 
best  and  surest  restorative.  He  should  be  fed  every  two  hours,  using 
some  of  the  malted  infant  foods,  milk  and  lime-water,  raw  eggs  and 
milk,  koumyss  (meat  and  meat  extracts  being  avoided)  ;  a  little  cap- 
sicum added  helps.  Where  ordinary  remedies  suggested  fail,  where 
the  patient  will  not  sleep,  and  is  difficult  to  manage,  apomorphine, 
one-thirtieth  to  one-twentieth  of  a  grain,  may  be  given  hypodermically. 
These  amounts  are  just  sufficient  to  produce  moderate  nausea  and  re- 
laxation, the  presence  of  perspiration  indicating  its  commencing  ac- 
tion.    The  patient  relaxes,  and  soon  falls  to  sleep. 

A  somewhat  limited  experience  has  shown  me  that  the  intravenous 
infusion  or  subcutaneous  injection  of  saline  solution  in  alcoholic  de- 
lirium is  beneficial.  It  increases  the  amount  of  the  circulating  me- 
dium in  which  the  toxic  materials  due  to  defective  excretory  func- 
tions are  dissolved,  thereby  diluting  the  alcohol  and  poison  and  bathing 
the  nerve-centers  with  a  more  attenuated  solution  of  the  same.  The 
amount  of  circulating  fluids  and  solids  through  all  the  excretory 
channels  is  markedly  increased,  thus  carrying  off  in  solution  much 
of  the  contained  toxins.  The  action  of  the  heart  is  improved  by  the 
filling  of  the  relaxed  vessels,  physiological  equilibrium  is  restored 
and  oftentimes  turns  the  balance  in  favor  of  recovery.  Enteroclysis 
with  a  hot  normal  saline  solution,  retaining  the  fluid  in  the  bowels 
as  long  as  possible,  favors  renal  elimination. 

In  certain  cases  of  moderate  severity,  those  in  which  the  patient 
is  fairly  manageable,  we  may,  especially  if  they  are  young  and  free 
from  organic  or  renal  diseases,  commence  at  once  with  the  use  of  the 
full  wet  pack  at  65°  F.,  allowing  him  to  remain  therein  one  or  two  hours. 
After  a  short  time  the  temperature  of  the  sheet  and  pack  will  rise 
to  95°  F.,  thus  enveloping  the  patient  in  a  moist  vapor  at  practically 
a  neutral  temperature,  our  aim  being  to  put  just  sufficient  covering 
over  the  pack  to  secure  this  result.  If  the  face  becomes  red  or  flushed, 
reaction  being  full  in  the  pack,  more  cover  should  be  removed.  Many 
fall  asleep  in  the  pack.  Where  these  cases  have  needed  cleansing 
an  excellent  method  is  to  give  them  a  thorough  soaping  and  scrub- 
bing with  a  flesh-brush,  finishing  this  treatment  with  a  hot  full  bath 
at  100°  to  105°  F.  for  two  to  three  minutes,  removing  at  once  to  the 
pack.  In  strong  cases  this  gives  excellent  results.  In  these,  as  in  all 
such  cases,  the  bowels  must  be  kept  freely  open,  alkaline  diuretics, 
liquid  food,  especially  the  malted  milks,  and  hypnotics  administered. 
These  cases  will  never  require  mechanical  restraint,  and,  in  fact, 
those  who  use  hydrotherapy  will  find  fewer  and  fewer  cases  that  do. 

Broadbent  describes  his  method  as  follows :  The  patient  is  stripped 
naked  and  lies  on  a  blanket  over  a  waterproof  sheet.  A  copious 
supply  of  ice-cold  water  is  provided,  and  a  large  bath-sponge  dripping 
with  the  iced  water  is  dashed  violently  on  the  face,  neck,  chest  and 


ALCOHOLISM.  487 

body  as  rapidly  as  possible.  He  is  then  rubbed  dry  with  a  rough 
towel,  and  the  process  is  repeated  a  second  and  a  third  time.  The 
patient  is  now  turned  over  and  the  wet  sponge  is  dashed  on  the  back 
of  the  head  and  down  the  whole  length  of  the  spine  two  or  three 
times,  vigorous  friction  with  a  bath  towel  being  employed  between 
the  cold-water  applications.  By  the  time  the  patient  is  dried  and 
made  comfortable  he  will  be  fast  asleep.  This  I  have  tried,  but  the 
cases  upon  which  it  may  be  used  must  be  robust  and  free  from  renal 
mischief. 

As  the  patient  improves,  concentrated  albuminoid  food,  broths 
and  light  farinaceous  diet  may  be  gradually  supplied,  followed  by 
some  variety  of  white  fish,  then  white  meats,  and  lastly  a  return  to 
ordinary  diet.  Peptonized  food  is  excellent  at  first  in  some  cases. 
The  period  of  gastric  distress  may  last  for  a  week  or  ten  days,  but 
this  is  exceptional,  most  patients  having  recovered  their  normal  ap- 
petite within  a  week.  There  are  some  cases  in  which  the  appetite 
has  not  failed.  In  these  and  in  the  majority  of  cases,  after  the  cessa- 
tion of  the  gastric  troubles,  good  wholesome  meals  of  meats,  veg- 
etables and  fruit  are  the  best.  It  has  been  alleged  by  some  that  a 
wholly  vegetarian  dietary  is  to  be  preferred.  The  writer  cannot  in- 
dorse this  as  an  absolute  or  general  rule.  He  has  seen  cases  which 
certainly  have  done  well  on  such  a  diet,  but  on  the  whole  a  mixed 
diet  of  flesh,  vegetables,  fruits  and  cereals  has  been  the  most  satis- 
factory. In  warmer  climates  the  less  meat  the  better.  There  is  much 
more  therapeutic  potentiality  in  diet  than  is  frequently  thought,  and 
the  best  kind  of  food  needed  for  each  patient  deserves  especial  at- 
tention. Though  the  writer  has  not  seen  juicy  fruits  cure  drunken- 
ness, he  has  seen  them  aid  powerfully  in  the  cure  of  inebriety.  The 
natural  fruit  juices  tend  to  allay,  if  not  to  quench,  the  great  thirst 
which  some  inebriates  experience  when  they  are  in  the  throes  of  the 
dyspeptic  miseries  following  a  bout  of  intoxication,  besides  having 
a  depurative  influence  on  the  blood. 

Acute  Alcoholic  Mania. 

Acute  alcoholic  mania  (mania  a  potu)  is  a  maniacal  attack,  tran- 
sient in  character,  and  brought  about  though  the  toxic  action  of  alco- 
hol upon  the  cerebral  tissues.  The  amount  of  alcohol  ingested  bears 
no  relation  to  the  disease,  in  some  cases  small  amounts  only  being 
required  to  produce  an  attack.  It  occurs  with  comparative  rarity  in 
inebriates,  probably  because  their  tissues  have  become  more  or  less 
habituated  to  the  use  of  liquor.  The  attack  usually  commences  with- 
out warning,  although  there  are  differences  in  this  respect.  It  is  a 
common  occurrence  in  a  mild  form,  for  we  notice  that  a  man  who  is 
drinking  is  simply  "spoiling  for  a  fight,"  "carrying  a  chip  on  his 
shoulder,"   and   who   will   upon   the   slightest  provocation   break   out 


488  PRACTICAL  HYDROTHERAPY. 

into  an  attack  of  mania.  This  condition  is  literally  a  mania  of  vio- 
lence, with  little  or  none  of  the  tremor  or  hallucinations  found  in 
alcoholic  delirium.  The  patient,  like  the  maniac,  is  unconscious  of 
his  surroundings,  and  infuriated  utterly  beyond  the  power  of  his 
control,  which  may  even  at  times  extend  to  the  point  of  attempted 
homicide.  This  temporary  madness  often  results  in  the  man  severely 
pounding  his  wife,  beating  his  children,  smashing  the  furniture, 
driving  every  one  from  the  house,  throwing  things  from  the  window, 
or  suddenly  beating  an  innocent  and  inoffensive  bystander,  striking 
an  animal — in  fact,  indulging  in  almost  any  insane  maniacal  act. 
When  brought  to  the  hospital  he  is  in  a  wild,  ungovernable  fury, 
striking  at  his  guardians,  kicking,  shouting,  stamping,  and  with  great 
difficulty  controlled.  The  face  is  flushed  and  engorged,  the  veins 
and  blood-vessels  standing  out  prominently  upon  the  face,  the  eyes 
wild  and  rolling,  the  muscles  enormously  strengthened  and  at  the 
highest  point  of  tension;  in  fact,  he  presents  all  the  symptoms  of  a 
wild  and  uncontrollable  attack  of  true  non-alcoholic  mania.  This 
attack  may  last  from  a  few  minutes  to  many  hours  and  even  days, 
with  intermissions.  These  are  the  cases  that  furnish  a  great  many 
of  the  "drunks"  that  are  brought  before  the  police  courts  for  adjudi- 
cation ;  they  form  a  large  class  of  offenders  against  person  and  prop- 
erty. 

The  pathology  of  such  a  disease  must  unquestionably  be  that  of 
an  acute  toxemia  acting  upon  peculiarly  unstable  and  excitable  psychic 
and  motor  centers  in  the  brain. 

The  prognosis  is  usually  good,  and  much  more  favorable  than  in 
ordinary  acute  mania,  as  the  paroxysm  passes  rapidly  away,  leaving 
the  patient  exhausted  and  worn  out.  Relapses  may  occur  if  alcohol 
is  continued. 

Treatment  is  based  largely  upon  the  condition  of  the  patient;  in 
some  instances  the  violence  is  so  great  that  it  is  with  difficulty  that 
anything  much  can  be  done  until  this  is  relieved.  It  has  been  the 
author's  uniform  rule  to  relax  and  quiet  these  patients  by  the  use  of 
apomorphine  in  one-twelfth  to  one-tenth  grain  doses,  which  usually 
have  the  effect  of  causing  nausea  and  prompt  vomiting.  This  cleanses 
the  stomach  and  reduces  rapidly  the  violent  symptoms.  As  soon  as 
the  patient  is  quieted  the  same  line  of  treatment  that  has  been  out- 
lined in  acute  alcoholic  intoxication  should  be  followed.  In  this 
disease,  during  its  acute  stage,  nothing  will  be  found  equal  to  nor 
take  the  place  of  the  full  wet  pack  at  65°  F.  for  one  hour,  followed 
by  a  rapid  cold  sponge.  The  after-treatment  is  identically  the  same, 
and  it  may  be  remarked,  in  conclusion,  that  the  only  way  by  which 
this  disorder  may  be  avoided  is  the  practice  of  complete  and  absolute 
abstention  from  liquor.  The  fact  that  the  individual  has  had  an  at- 
tack of  acute  alcoholic  mania  justifies  one  in  exercising  every  possible 


ALCOHOLISM.  489 

medical  and  moral  power  to  impress  the  need  of  not  only  temperance 
but  abstinence. 

Chronic  Alcoholism. 

By  chronic  alcoholism  is  meant  the  continuous  or  nearly  contin- 
uous use  of  alcoholic  beverages.  They  form  the  class  known  as 
chronic  drunkards  or  drinker-,  and  show  most  plainly  the  pathological 
changes.  They  range  from  the  confirmed  "sot,"  who  is  the  constant 
inmate  of  almshouses,  workhouses  and  jails,  to  the  "gentlemanly" 
drinker  who  only  at  times  needs  the  assistance  of  friends,  but  who, 
nevertheless,  is  treading  the  same  weary  and  certain  road. 

Drunkenness — that  is,  chronic  alcoholism — should  be  plainly  and 
clearly  differentiated  from  inebriety.  Drunkards  drink  whenever  op- 
portunity offers,  but  the  inebriate,  nervously  diseased,  drinks  only 
as  the  nerve  storm  passes  over  him.  The  drunkard  gradually  in- 
jures the  structures  of  the  brain  and  body,  their  functional  activity  ; 
the  inebriate  is  one  who  is  diseased,  horn  with  a  brain  that  is  truly 
unsound.  Certain  drunkards  may  be  inebriates — that  is  to  say,  the 
neurosis  may  be  superimposed  upon  the  chronic  state. 

In  the  chronic  alcoholic  the  first  symptoms  are  usually  those  of  a 
nervous  character,  tremor  of  the  upper  and  lower  limbs,  that  of  the 
hands  being  most  noticeable.  There  are  neuritic  pains  in  the  extrem- 
ities (a  perineuritis?),  characterized  by  pains,  paroxysmal,  intermit- 
tent or  constant,  together  with  a  numbness  of  feeling,  as  though  the 
fingers  or  toes  were  enlarged  or  swollen.  These  are  most  common 
at  night,  and  appear  after  undue  fatigue  or  over-exertion.  Feelings 
of  extreme  coldness,  heat,  twitchings,  stabbings,  indefinable  uneas- 
iness, are  experienced  all  over  the  body,  especially  in  the  back,  legs 
and  feet,  shoulders  and  arms.  My  experience  is  that  they  never  get 
better  until  complete  cessation  of  liquor  is  secured  and  free  elimina- 
tion brought  about.  Sensation  may  be  much  delayed  and  a  mild  anes- 
thesia developed.  In  addition  to  these  symptoms,  the  legs  are  weak, 
there  may  be  some  ataxia  and  a  tendency  to  give  down.  The  lower 
limbs  may  show  some  wasting.  Insomnia  is  one  of  the  most  trouble- 
some and  persistent  of  the  symptoms,  its  improvement  a  good  sign. 
The  alcoholic,  on  retiring,  finds  himself  nervous,  restless  and  desirous 
of  something  that  will  quiet — that  is,  narcotize— in  order  to  secure 
sleep.  If  he  becomes  quiet  and  starts  to  sleep,  he  will  be  often  awak- 
ened by  a  jerk  or  start  of  such  severity  as  to  arouse,  annoy  and  upset 
him  completely.  There  is  vertigo,  headache,  nervousness,  musccc 
rolitautes,  tinnitus  aurium  et  cerebri.  The  mental  state  has  been 
fully  dwelt  upon,  but  the  mental  disquietude  without  liquor,  the  fleet- 
ing delusions,  the  untruth,  the  suspicions,  are  all  characteristic. 

Nausea,   morning  vomiting   attendant   upon   the   chronic   gastritis, 
the  coated  tongue,  the  foul,  sour  breath,  the  epigastric  "sinking,"  are 


490  PRACTICAL  HYDROTHERAPY. 

nearly  always  present.  The  eyes  are  watery,  the  skin  red  and  pimply, 
the  nose  bottled.  In  the  liquor  drinker  we  may  have  emaciation,  in 
the  malt  user  the  "bloat."  In  fact,  it  may  be  said  that  in  the  fully 
developed  case  we  will  find  morning  nausea  or  vomiting,  coated 
tongue  and  foul  breath,  gastritis,  headache,  dizziness,  insomnia,  rest- 
lessness, fears,  perverted  sensations,  untruth,  tremors,  shuffling,  ataxic 
gait  and  bloated,  puffy  or  pinched   features. 

The  tongue  is  coated,  the  mouth  red  and  irritated,  the  breath  foul 
and  sour.  There  is  nausea,  weight,  eructations,  vomiting,  pyrosis, 
gastralgia  and  other  serious  manifestations  of  such  extent  and  gravity 
as  to  make  him  uncomfortable,  his  life  a  misery,  and  often  themselves 
serve  as  a  cause  for  the  further  ingestion  of  alcohol.  The  secretions 
of  the  intestines -gradually  lose  their  digestive  powers,  their  muscular 
structures  deteriorate,  and  as  a  result  intestinal  indigestion  and  chronic 
constipation  soon  supervene.  The  liver  becomes  "torpid,"  its  secre- 
tions are  precipitated,  and  owing  to  the  lack  of  bile  the  feces  become 
clay-  or  putty-colored.  The  important  function  of  separating  the 
digestive  toxins  fails,  and  there  is  filtered  into  the  blood  stream  large 
quantities  of  these  products.  The  lower  intestine  itself  becomes 
deteriorated,   either  enlarged  and   fatty  or  contracted  and  cirrhosed. 

Though  there  is  not  the  acute  pain  and  distress  of  acute  alcoholic 
attacks,  still  the  system  is  slowly  but  surely  undergoing  a  thorough 
narcotization  of  the  tissues.  The  influence  is  such  as  to  degrade 
silently  and  steadily  the  function  and  structure  of  each  organ  and 
tissue,  changing  the  normal  or  physiological  processes  of  break-down 
and  repair  into  pathological  ones,  at  the  base  of  which  there  is  a 
constant  double  toxemia. 

The  heart  is  constantly  overacting,  and  by  the  specific  action  of 
alcohol  on  the  structures  of  the  muscular  tissue  is  weakened.  As  a 
result,  the  drinker  becomes  "short-winded,"  easily  fatigued  and  un- 
able to  stand  exertion.  He  puffs  and  blows  when  he  runs  a  short 
distance  or  climbs  stairs. 

In  beer  and  other  malt  liquor  drunkards,  the  subject  even  at  an 
early  stage  has  a  tendency  to  obesity,  which,  as  the  disease  advances, 
becomes  more  prominent;  he  acquires  a  bloated  and  inflated  appear- 
ance. The  features  are  heavy  and  dull,  the  skin  of  the  face  red  and 
somewhat  of  a  purply  hue,  especially  on  exertion,  with  vascular  hyper- 
trophy, most  conspicuous  in  the  region  of  the  eyes  and  nose.  There 
are  blotches,  an  oily,  greasy,  glistening  surface,  conjunctival  yellow- 
ness (bilious  or  fatty),  the  eyes  moist  and  red.  In  the  early  stages 
the  beer  drinker  may  be  quick  and  active,  but  gradually  his  gait 
loses  much  of  its  elasticity.  Dropsy,  syncope  or  embolism  frequently 
closes  the  scene  in  middle  life.  Spirit-drinkers,  as  a  rule,  are  more 
shrunken  in  aspect,  and  often  grow  thinner  the  longer  they  continue 
their   deep   potations,   till    in   many   cases   they   are   quite   emaciated. 


ALCOHOLISM.  491 

From  their  liability  to  cirrhosis  of  the  liver  and  kidneys  and  to  car- 
diac fatty  degeneration,  they  often  display,  as  the  disease  advances, 
the  abdominal  rotundity  of  ascites. 

Treatment. — In  the  consideration  of  the  treatment  of  chronic  alco- 
holism the  physician  must  possess  two  factors  to  make  him  successful 
in  the  management  of  these  cases.  One  is  that  of  example,  the  other 
that  of  sufficient  personality  to  control  and  manage  patients.  He 
who  possesses  a  past  record  in  this  disease  is  not  the  one,  for  precept 
backed  by  example  is  one  of  the  most  powerfully  suggestive  agencies 
that  the  physician  can  command.  If  the  medical  staff  and  other  offi- 
cers are  abstainers,  so  much  the  better.  The  author  cannot  under- 
stand' how  any  enlightened  medical  practitioner,  who  has  the  well- 
being  of  his  cases  at  heart,  can  be  other  than  a  total  abstainer.  The 
quiet  example  of  the  physician  or  the  members  of  a  private  med- 
ical household  taking  such  a  patient  has  often  a  deeper  influence  on 
the  afflicted  inmate  in  confirming  his  good  resolutions  and  strengthen- 
ing his  will  than  any  amount  of  prescriptions  and*  physic,  for  the 
medical  adviser's  practice  of  "moderate"  drinking  confirms  in  the 
alcoholic  the  morbid  desire  and  impulse.  One  must  at  least  come  into 
court  with  clean  hands. 

The  essential  basic  requirements  are  the  absolute  withdrawal  of 
drink,  perfect  control  of  the  drinker,  his  ready  acquiescence  in  the 
treatment,  and  sufficient  time  in  which  to  perfect  the  cure.  The  abso- 
lute, immediate  and  unconditional  withdrawal  of  all  alcoholic  stimu- 
lants, whether  spirits,  wines,  beers,  malt  or  ciders,  must  be  secured. 
After  much  personal  experience,  to  which  may  be  added  the  results 
in  prisons,  workhouses,  hospitals  and  homes  for  alcoholics,  has  not 
alone  shown  that  immediate  withdrawal  is  safe,  but  that  "tapering" 
is  merely  adding  to  the  misery.  In  this  respect  there  is  a  marked 
difference  between  alcohol  and  drug  addictions.  By  its  prompt  and 
immediate  withdrawal  we  remove  the  exciting  cause,  and  through 
hydrotherapy  prevent  many  of  the  discomforts  that  would  otherwise 
ensue. 

In  no  class  of  cases  is  a  more  close  study  of  the  personal  equa- 
tion called  for  than  in  these  people,  for  one  case  is  radically  differ- 
ent from  another,  so  much  so  as  to  warrant  most  careful  inves- 
tigation. Individual  peculiarities,  the  direct  and  indirect  action  of 
alcohol  on  the  tissues,  the  degeneration  and  structural  defects  caused 
by  its  use,  all  combine  to  raise  questions  of  grave  import  to  physician 
and  patient.  Nothing  can  be  accomplished  in  the  confirmed  drinker 
unless  perfect  control  of  his  time  and  movements  is  secured.  This 
is  best  accomplished  not  by  locking  him  up  in  a  ward  or  hospital, 
but  by  the  personal  care  a  special  nurse  or  attendant  can  give.  In 
addition  to  the  companionship  and  cheering  influence  of  the  presence 
of  another  person,  we  can  in  this  way  be  certain  of  his  not  surrep- 


492  PRACTICAL  HYDROTHERAPY. 

titionsly  receiving  alcohol.  This  control  by  personal  supervision  should 
be  kept  up  until  the  alcoholic  is  well  convalesced.  There  is  often- 
times urged  the  cost  of  such  a  method,  but  this  does  not  change  the 
fact  that  it  is  the  very  best  way.  By  it  the  man  is  permitted  a  certain 
freedom  and  activity  that  helps  to  prevent  the  tedium  of  the  "cure," 
for  it  enables  him  to  sit  out  of  doors,  take  walks,  read,  talk,  and 
through  this  companionship  we  may,  by  the  nurse's  example  and 
teaching,  instill  non-alcoholic  ideas.  Where  there  is  ready  acqui- 
escence in  the  treatment  and  a  reasonable  interest  in  its  outcome,  we 
may  expect  much  more  rapid  progress  from,  the  methods  here  sug- 
gested. Of  all  the  elements  needed  to  secure  the  end  desired,  time  is 
one  of  the  most  important,  for  with  ample  time,  perfect  control  and 
proper  treatment  much  can  be  promised,  even  those  alcoholics  whose 
case  looks  unpromising,  but  without  this  one  element  little  hope  of 
permanent  good  can  be  held  out.  We  may  tide  over  the  acute  attacks, 
may  straighten  out  the  chronic  alcoholic,  but  return  is  almost  certain 
unless  we  have  time  to  bring  into  play  all  those  elements,  psychic, 
moral,  religious,  physical  and  physiological,  that  constitute  the  sum 
total  of  treatment.  The  mental  training  of  these  cases  is  a  factor 
that  is  as  essential  as  the  physical,  good  and  proper  ideas  being  needed 
as  well  as  physiological  functions  free  from  toxins. 

It  is  a  much  more  arduous  undertaking  to  treat  cm  alcoholist  of 
ten  to  twenty  years'  than  one  of  one  or  two  years'  standing.  Hence 
treatment  should  be  applied  at  as  early  a  stage  as  possible,  an  axiom 
which  most  alcoholists  and  their  relations   fail  to  act  upon. 

One  remark  applies  to  all  rapid  "cures"  or  processes,  known  and 
unknown.  A  diseased  condition  of  the  brain,  such  as  is  possessed 
by  the  alcoholic,  cannot  be  reconstructed  within  a  few  clays  or  weeks. 
In  from  one  to  two  weeks  nearly  all  are  helped  and  ready  to  testify 
that  they  are  cured,  but  experience  shows  a  preponderating  majority 
of  relapses.  The  mere  fact  of  a  rapid  "cure"  being  claimed  ought 
to  call  forth  strict  caution  and  deliberation,  especially  in  cases  of  long 
standing.  Weeks  and  even  months  are  required  for  the  elimination 
of  the  poison  and  the  correction  of  the  actual  mischief  done  to  organ 
and  tissue,  during  and  after  which  the  structure  must  be  built  up 
anew  of  sound  healthy  tissue — a  labor  of  time.  If  all  this  can  be 
accomplished  when  the  patient  is  following  his  usual  calling,  so  much 
the  better.  When  the  alcoholist  has  to  be  sent  from  home  it  is  an 
imperative  obligation  to  recommend,  if  this  be  within  the  physician's 
power,  only  an  establishment  which  is  intelligently  conducted  on  lines 
consonant  with  the  teachings  of  physiology  and  pathology. 

The  claims  so  frequently  and  persistently  urged  on  behalf 
of  any  drug-combination,  that  it  is  an  absolute  or  nearly  absolute 
cure,  in  the  writer's  opinion  may  at  once  be  dismissed.  There  is  and 
can  be  no  specific  for  the  "cure"  of  alcoholism,  and  any  medicinal  or 


ALCOHOLISM.  493 

other  preparations  for  which  such  a  claim  is  alleged,  in  all  probability 
have  been  long   found  useful,  not  as  specifics,  but  as  serviceable  in 

improving  the  tone  of  the  brain  and  nervous  system.  If  we  are  going 
to  urge  "specifics'"  (  ?),  or  some  single  process  or  drug,  it  were  much 
better  to  proclaim  some  open  method  possessing  powerful  physiolog* 
ical  attributes,  such  as  hydrotherapy,  than  any  secret  method  con- 
sisting of  some  undisclosed  formula  of  potent  and  powerful  drugs 
in  doses  per  oram  or  hypodermically,  the  strength  of  which  is  un- 
known. 

These  patients,  upon  entering  sanatoria  or  institutions  designed 
for  their  reception,  possess,  as  a  rule,  very  inactive  skins,  sometimes 
are  even  dirty,  so  that  the  first  step  in  the  hydrotherapeutic  manage- 
ment of  the  case  should  he  the  administration  of  the  hot  full  bath 
at  a  temperature  of  100°  to  104°  F.,  during  which  the  patient  should 
be  scrubbed  from  head  to  foot  with  a  rubber  or  flesh-brush,  accom- 
panied by  the  free  useof  green  soap.  This  bath  will  cleanse  the  patient 
thoroughly,  remove  the  accumulated  epithelial  debris  from  the  surface, 
and  stimulate  the  secretions  as  well  as  the  circulatory  activity.  The 
hath  should  he  followed  by  a  hypodermic  of  strychnia  and  atropia  and 
the  internal  administration  of  liquor  ammoniae  acetatis.  If  the  pa- 
tient possesses  sufficient  strength,  the  administration  of  the  full  bath 
should  be  continued  daily,  or,  what  is  far  better,  the  electric  light 
bath,  followed  by  the  horizontal  rain  bath  at  a  temperature  of  104c 
F.  for  one  to  one  and  one-half  minutes,  pressure  twenty-five  to  thirty 
pounds,  rapidly  reduced  to  80°  F.  for  one-fourth  minute.  Gradually 
reduce  the  temperature  to  70°  F.  by  decreasing  one  or  two  degrees 
daily.  In  these  cases  the  Turkish  bath  has  proved  to  be  of  value, 
especially  at  the  commencement  of  treatment,  although  it  should  be 
administered   strictly  upon  the  physician's  prescription. 

Vomiting  and  gastritis  are  best  met  by  the  prompt  use  of  lavage, 
followed  by,  in  some  cases,  teaspoonful  sips  of  very  hot  water,  or 
shaved  ice  and  some  carbonated  water,  such  as  Vichy.  Nothing  in 
the  writer's  experience,  however,  has  proved  so  satisfactory  as  the 
combination  of  the  above  with  the  use  of  the  fomentation  applied 
over  the  stomach  and  abdomen  for  ten  minutes,  repeated,  and  in  its 
turn  followed  by  the  ice-bag  over  a  compress,  applied  to  the  epi- 
gastrium. 

Insomnia  may  be  met  by  the  use  of  the  wet  pack  at  70°  F.,  dura- 
tion thirty  minutes,  increased  five  to  ten  minutes  nightly  until  sixty 
minutes  has  been  attained.  The  author  has  had  satisfaction  from  the 
use  of  the  neutral  full  bath,  duration  thirty  to  sixty  minutes,  at  a 
temperature  of  94°  F.,  just  before  bedtime.  "Where  this  treatment 
cannot  be  carried  out  the  alternate  hot  and  cold  sponge  to  the  spine 
will  sometimes  bring  about  prompt  response.  It  may  be  said  in  pass- 
ing that  general  nutritional  treatment  of  the  case  will  relieve  insomnia. 


494  PRACTICAL  HYDROTHERAPY. 

Craving  for  alcohol  is  best  overcome  by  general  reconstruction 
of  the  patient  and  the  use  of  fruits  and  fruit  drinks,  carbonated 
water,  and  tonics  containing  nux  vomica,  capsicum  and  gentian.  Caf- 
feine, one  to  two  grains  every  hour,  will  materially  aid  in  suppressing 
the  desire.  It  must  be  borne  in  mind  clearly  and  distinctly  that  dis- 
gusting the  alcoholic  is  not  curing  him  of  the  desire  for  stimulants. 
This  stage  of  treatment  usually  lasts  from  ten  to  fourteen 
days. 

The  second  stage  of  the  treatment  is  that  of  elimination  and  recon- 
struction, and  the  management  of  this  stage  has  to  be  varied  accord- 
ing as  we  have  to  deal  with  the  presence  of  nephritis  and  arterial 
sclerosis.  Where  these  exist  we  must  be  very  cautious  in  using  cold 
water  and  strong  percutient  measures.  Reference  should  be  made  to 
the  sections  wherein  these  diseases  are  treated,  in  addition  to  that  here 
outlined.  Where  it  is  desired  to  secure  powerful  sweating  effects, 
without  weakening  the  patient,  we  must  commence  with  the  daily  use 
of  the  electric  light  bath,  full  strength,  to  free  perspiration,  followed  bv 
the  hot  full  bath  at  100°  to  104°  F.  for  five  minutes,  sometimes  ten. 
The  patient  is  then  to  be  removed  to  the  blanket  pack,  the  edges  of 
his  hair  well  dried,  and  permitted  to  perspire.  After  several  days' 
treatment  the  use  of  the  electric  light  bath  until  free  perspiration 
takes  place  should  be  instituted,  followed  by  the  horizontal  rain  bath 
at  104°  F.  for  one  and  one-half  minutes,  reduced  to  80°  F.  for  one- 
fourth  minute,  pressure  twenty  pounds.  Reduce  the  temperature  one 
degree  and  increase  the  pressure  one  pound  daily  until  70°  F.  and 
thirty  pounds'  pressure  are  reached.  The  final  treatment  consists  in 
the  following,  and  should  be  used  only  with  patients  who  are  strong 
and  robust,  who  have  no  cardiac  or  renal  disease,  and  only  admin- 
istered after  the  full  development  of  the  reactive  power  has  been 
established :  Electric  light  bath  until  free  perspiration  takes  place, 
followed  by  the  horizontal  rain  bath  at  102°  to  104°  F.  for  one  to  one 
and  one-half  minutes,  pressure  thirty  pounds  ;  this  to  be  followed  by  the 
jet  douche  at  65°  F.,  pressure  thirty  pounds,  applied  to  the  spine  and 
the  posterior  aspect  of  the  lower  limbs  for  ten  seconds,  the  treat- 
ment being  fininshed  by  applying  the  fan  douche  gently  to  the  sternum. 
As  the  psychic  and  bodily  functions  respond  to  the  treatment,  and 
normal  body  and  brain  activity  returns,  we  must  urge  systematic 
use  of  both  these  functions,  which  are  so  essential  to  a  proper  and 
permanent  recovery. 

Men  and  women  present  difficulties  peculiar,  so  to  speak,  to  their 
sexual  difference.  The  former  can  have  walking  and  riding,  manual 
toil  and  manly  exercises ;  the  latter  walking,  with  lighter  occupations, 
such  as  sewing,  wood-carving  and  the  like.  Both  sexes  can  read, 
write,  draw,  paint,  photograph,  play  on  musical  instruments,  and 
so  on.     Among  the  mechanical  classes  and  the  poor,  the  men  can  dig, 


,  ILCOHOLISM.  495 

garden,  do  house  decorating,  remunerative  work,  and  oilier  light  du- 
ties, for  "the  idle  brain  (and  hands)  is  the  devil's  workshop."  Method- 
ical occupying  of  the  mind  with  the  performance  of  daily  duties  is 
the  only  effectual  means  of  withdrawing  the  alcoholic  from  his  mor- 
bid brooding  over  his  misdeeds  and  miseries,  and  thus  powerfully 
aiding  in  making  him  once  more  "a  whole  man"  in  fair  possession 
of   self-restraint   and   inhibition. 

Too  much  care  cannot  be  given  to  the  strengthening  of  the  will- 
power, for  the  temptation  to  drink  will  be  very  strong,  and  for  this 
reason  after  recovery  the  patient  should  avoid  those  of  his  associates 
who  cater  to  his  weakness,  and  made  to  enjoy,  if  possible,  the  com- 
pany of  those  who,  on  the  contrary,  tend  to  counteract  his  habits. 

It  may  not  be  amiss  to  refer  to  the  extraordinary  mental  temperance 
waves  or  revivals  which  have,  every  now  and  then,  passed  over  a 
whole  State  or  country,  and  have  apparently  swept  away  in  their 
ardor  for  abstinence  all  the  alcoholists  in  the  community.  These 
neurotic  temperance  waves  have  all  flowed  and  ebbed,  leaving  behind 
them  on  the  sands  of  the  nations,  as  they  receded,  a  fair  salvage, 
though  but  small  proportion  of  the  original  number  of  recovered. 
The  many  victims  who  have  taken  the  teetotal  pledge  over  and  over 
again,  or  who  have  even  publicly  testified  to  religious  influences  or 
drug  preparations  having  destroyed  their  drink  crave  so  utterly 
that  they  could  not  drink  an  intoxicant  again,  and  yet  who  have  re- 
turned to  their  former  alcoholic  indulgence,  negative  the  existence 
of  such  an  antidote,  while  the  hundreds  and  thousands  of  reformed 
drunkards,  who  by  moral,  religious  or  selfish  motives  alone  have 
overcome  and  stood  firm  in  their  abstinence,  attest  the  fact  that  the 
confirmed  alcoholist  can  be  and  has  been  cured  by  a  resolute  effort 
of  the  will. 

Hypnotic  suggestion  has  been  spoken  of  by  some  in  quieting  and 
preventing  the  drink  impulse,  crave  or  craze,  but  the  writer  has  seen 
so  many  alcoholics  with  whom  this  process  has  failed  that,  apart 
from  the  many  objections  which  have  been  fairly  urged  against  it, 
he  cannot  recommend  hypnotism  save  as  an  after-adjunct. 

The  reason  ought  to  be  enlisted  in  the  treatment,  which  is  best  at- 
tempted by  sound  teaching  concerning  the  fallacy  of  the  prevalent 
belief,  in  all  classes  of  society,  in  the  virtues  of  alcohol  as  a  beverage, 
and  concerning  that  potent  drug's  benumbing  influence  on  the  senses, 
its  undermining  action  in  structurally  degrading  organ  and  tissue,  its 
irritant  inflammation  of  the  texture  of  vital  organs.  The  public  should 
be  especially  grounded  in  the  truth  as  to  the  non-necessity  and  value- 
lessness  of  alcoholic  intoxicants  as  an  article  of  ordinary  diet.  No 
pains  should  be  spared  to  impress  upon  users  the  need  of  abstinence 
from  all  intoxicants.  To  help  to  attain  this  end  we  should  enlist  the 
influence   of   culture,   music,   the   fine   arts,   high-toned   morality   and 


'*» 


496  PRACTICAL  HYDROTHERAPY. 


pure,  undefiled  religion  to  strengthen  the  self-respect,  fortify  volition 
and  increase  inhibition. 

Inebriety. 

Inebriety  is  a  periodical,  overpowering  and  instinctive  morbid  im- 
pulse, craze  or  craving  which  drives  certain  individuals  to  drink  to 
excess;  a  central  disease,  a  dominating  malady;  a  crave  not  for  alco*J 
hoi,  but  for  stimulation,  intoxication,  anesthesia,  or  satisfaction  af- 
forded by  drink.  The  periodicity  may  vary  from  a  few  hours,  making 
it  nearly  constant,  or  it  may  be  weekly,  fortnightly,  monthly,  quarterly, 
or  semi-annually ;  may  follow  a  heavy  day's  strain  or  excessive  mail, 
or  be  associated  with  atmospheric  and  climatological  conditions.  In 
women  the  greatest  tendency  to  inebriate  outbreaks  is  associated  with 
the  menstrual  period,  the  uncontrollable  impulse  lasting  several  days, 
this  alone  satisfying  the  intense  and  morbid  desire  of  the  central  ner- 
vous system.  Others,  again,  will  not  drink  until  the  few  days  that 
follow  the  period,  the  flow  itself  seeming  to  have  given  relief,  its  ces- 
sation being  the  immediate  cause.  In  several  instances  I  have  been 
fully  satisfied  that  the  perturbation  in  these  cases  during  the  menstrual 
period  has  been  such  for  the  time  being  as  to  temporarily  upset  the 
mental  equilibrium  and  abolish  control.  During  the  passage  of  the 
cyclonic  nerve  storm  the  nervous  system  is  so  upset  that  some  anes- 
thetic is  badly  needed,  and  drink  promptly  gives  relief.  These  cases 
are  favorable  to  treat,  for  by  care  to  avoid  stimulants  at  the  time  of 
menstruation  we  may  expect  the  impulse  and  desire  to  gradually  fade 
and  lessen  until  the  individual  passes  into  a  stage  of  equilibrium  or 
normality.  Under  strains  and  stresses  it  may  again  return  during  the 
period,  when  added  watchfulness  will  be  needed  to  ward  off  a  drunken 
attack  or  bout. 

The  inebriate  frequently  has  premonitory  warnings  of  the  on- 
coming storm ;  he  should  take  advantage  of  them,  seek  the  physician's 
care  and  treatment,  the  result  of  which  would  be  the  gradual  breaking 
up  of  the  neurosis  and  relief.  Inebriates,  as  a  rule,  do  not  heed  these 
warnings,  but,  following  the  impulse,  turn  to  drink.  The  premoni- 
tory symptoms  are  usually  those  of  more  or  less  increasing  nervous- 
ness, a  motor  restlessness,  insomnia,  bad  dreams,  fears,  suspicions 
of  others,  dreads,  indefinable  feelings  of  impending  calamity,  loss  of 
appetite  or  hurried  eating,  constipation,  etc.  Mental  inability  and 
"touchiness"  are  very  common.  In  some  cases  it  comes  apparently 
as  a  lightning  stroke  out  of  a  clear  sky,  followed  by  an  immediate 
tendency  to  drink.  Some  inebriates  are  solitary  in  their  indulgence ; 
others — and  these  form  the  larger  majority — are  of  a  social  or  con- 
vivial tendency,  and  seek  not  alone  the  pleasure  and  gratification  of 
the  intense  desire  for  stimulation,  but  boon  companions  in  whose  soci- 
ety they  derive  added  pleasure. 


ALCOHOLISM.  '  497 

The  inebriate,  while  differing  from  the  chronic  alcoholic  in  many 
ways  yet  possesses  many  features  in  common,  and  he  may  by  proper 
treatment,  both  somatic  and  psychic,  be  trained  as  a  total  abstainer 
and  continue  such.  The  writer  has  seen  cases  with  the  worst  kind 
of  family  histories,  neurotic  heredity,  poor  training,  and  yet  these  per- 
sons severely  handicapped  in  their  struggle,  have  made  good  recov- 
eries and  remained  non-users  for  the  remainder  of  their  lives.  For 
this  reason  they  should  be  encouraged  to  make  the  fight,  for  with  the 
feeling  of  strong  hope  for  cure  much  can  be  done.  Too  often  we 
hear  the  note  of  despair:  "What  hope  is  there  for  me?  I  have  inher- 
ited from  my  parents  the  drink  habit,  and  it  is  useless  for  me  to  try. 
Even  the  unpromising  break  the  thralldom,  so  we  should  give  these 
the  courage  that  paralyzed  brains  need. 

In  treatment  the  same  principles  are  involved  in  the  care  of  the 
inebriate  as  the  chronic  alcoholic,  and  the  remarks  made  there  apply 
here  It  has  alwavs  seemed  to  me  that  we  should  give  the  inebriate, 
if  possible,  a  great  deal  of  "mental  attention,"  for  we  can  frequently 
by  this  psychic  treatment  change  the  drift  of  his  whole  mentality. 
My  observation  leads  me  to  believe  that  a  longer  time  and  more  atten- 
tion is  required  to  treat  these  cases. 

Prophylaxis  of  Alcoholism—This  is  one  of  the  broadest  subjects 
in  the  range  of  medicine,  and  involves  to  a  certain  extent  the  changing 
of  the  attitude  of  young  men  and  women  to  the  present  prevailing 
ideas  When  it  shall  be  considered  "bad  form"  for  both  sexes  to 
drink  in  public  cafes,  or  to  touch  liquor  of  any  kind,  a  great  step  for- 
ward will  be  taken.  The  reduction  of  the  use  of  alcohol  means  the 
lessening  of  the  great  "white  plague,"  tuberculosis,  a  no  small  item 

in  itself.  .        ,     , 

The  young  should  be  taught  that  alcohol  is  a  poison  to  mind,  body 
and  morals;  that  its  use  is  needless  and  fraught  with  danger,  espe- 
cially at  a  tender  age.  It  should  be  taught  that  it  possesses  no  food 
value  at  all,  but  that  it  depraves  all  bodily  and  mental  processes;  that 
woman's  virtue  and  man's  honor  have  passed  from  them  while  under 
its  moral  benumbing  influence,  not  because  of  the  innate  weakness  or 
moral  turpitude,  but  because  of  the  alcoholic's  incapacity  to  see  and 
appreciate  at  its  true  value  the  acts  done  under  its  influence.  From 
the  cradle  up,  the  mother  and  nurse  should  avoid  the  cry-soothing 
"toddy  "  that  ruins  the  tender  infantile  tissues  and  tends  to  make  an 
alcoholic  at  the  adult  period  of  life.  I  am  satisfied  that  if  a  propa- 
ganda of  abstinence  were  as  closely  pressed  as  the  idea  of  the  man- 
liness" of  drinking,  we  should  soon  find  the  young  men  throwing  oft 
the  yoke  The  restriction  of  the  sale,  the  limitation  of  the  bar-room 
night  hours,  would  likewise  lessen  some  of  the  unfortunate  sequel* 

of  drinking. 

Local  option  or  national  prohibition  would  be  useful  adjuncts. 


498  PRACTICAL  HYDROTHERAPY. 

The  final  word  for  prophylaxis  for  future  attacks  in  one  who  has 
developed  alcoholism  or  inebriety  should  include  a  long  seclusion  in 
some  special  institution,  for  they  are,  as  a  rule,  too  will-paralyzed  to 
regain  health  in  a  few  short  weeks. 

State  control  of  inebriates  and  alcoholics  must  surely  come  as  a 
matter  of  economy,  both  in  actual  cost  to  the  State  and  the  loss  of 
time  to  the  individual.  The  hope  is  indulged  that  these  facts  will 
eventually  be  impressed  upon  the  minds  of  legislators. 


CHAPTER  XXII. 

THE  REARING  OF  THE  DELICATE,  TUBERCULAR  AND 
NEUROPATHIC  CHILD. 

It  was  Oliver  Wendell  Holmes  who  said  that  the  education  of  a 
child  should  be  begun  two  hundred  years  before  it  was  born.  The 
more  one  ponders  upon  the  plain  facts  of  inheritance  the  more  he 
is  apt  to  come  to  the  conclusion  that  too  much  care  cannot  be  spent 
in  the  training  of  normal  and  healthy  children,  and  this  becomes 
doubly  true  with  regard  to  the  peculiar  unfortunates  the  subject  of 
this  chapter.  Their  proper  rearing  would  contribute  quite  as  much  to 
the  alleviation  of  human  suffering  and  disappointment  as  any  other 
factor.  The  first  important  element  is  a  rational  and  first-rate  parent. 
This  fact  enters  very  little  into  the  consideration  of  parties  who  are 
considering  marriage. 

Childhood  is  the  plastic  and  formative  period  of  existence;  it  is 
the  stage  in  the  mental  and  physical  make-up  of  the  child  that  we  must 
keep  straight  and  strong,  for  "as  the  twig  is  bent  the  tree  is  inclined." 
The  delicate,  tubercular  and  neuropathic  child  is,  as  a  rule,  thin  and 
anemic,  nervous  and  restless,  sensitive  to  physical  pain  and  suffering, 
lacking  physical  courage,  never  "rough  it"  with  their  companions, 
seek  quiet,  seclusion  and  the  companionship  of  women.  Psycholog- 
ically, they  are  what  would  be  termed  "peculiar";  their  little  brains 
sensitive  to  impressions;  precocious,  with  too  vivid  and  capacious 
imaginations ;  variable  and  timorous ;  giving  way  to  trifles,  cry  easily. 
They  lack  that  normal  strength  that  knows  no  fear,  either  of  self  or 
God,  of  man  or  the  future,  or  of  to-morrow  ;  for  normal  children  should 
never  think  of  pain,  of  hygienic  laws,  or  organs,  but  should  be  without 
fear  of  dark,  thunder,  spirits,  devils,  burglars,  fairies  or  their  like. 

The  physical  and  moral  education  of  the  child  is  to  be  so  con- 
ducted as  to  result  in  a  harmonious  development  of  body  and  bram. 
These  children  should  first  of  all  be  given  physical  education,  in  order 
that  their  bodies  may  be  strong,  mental  education  afterwards  in  pro- 
portion to  their  physical  strength  and  capacity.  They  must  not  be 
required  to  conform  to  the  fixed  formula  of  the  pedagogue. 

A  high  degree  of  physical  strength  and  endurance  is  absolutely 
incompatible  with  the  tubercular,  delicate  and  neuropathic.  In  the 
development  of  the  physical  capacity  of  these  children,  out-door  life 
in  the  country,  with  its  superabundance  of  fresh  air  and  sunlight,  with 
its  incentives  for  physical  exercise  and  exertion,  is  undoubtedly  the 
(499) 


500  PRACTICAL  HYDROTHERAPY. 

life  that  is  most  conducive  to  strength,  rather  than  the  life  of  the 
crowded  city,  with  its  limitations.  It  may  be  supplemented  by  the 
judicious  use  of  gymnastic  exercise  to  overcome  physical  discrep- 
ancies and  weaknesses. 

Mental  and  moral  control  is  essential,  and  to  this  end  training 
should  start  in  the  cradle.  With  the  growth  of  the  child  self-control 
and  restraint  must  be  carefully  inculcated.  He  should  be  taught 
to  accept  without  black  looks  or  resentment  adverse  decisions  to  his 
pleasures,  and  to  be  made  to  understand  Tennyson's  lines,  "Theirs 
not  to  reason  why,  theirs  but  to  do  or  die."  He  should  be  taught  to 
stand  teasing  and  to  control  a  hasty  temper,  to  stamp  out  sulking, 
learn  to  take  banter  as  well  as  give  it,  and  to  present  a  smiling  face 
and  a  determined  will  even  under  disappointment  and  failure.  This 
is  a  part  of  the  iron  school  of  experience. 

Obedience  should  be  exacted  in  spirit  and  to  the  letter.  The  best 
general  is  made  out  of  the  timber  of  the  soldier  that  can  best  obey, 
and  so  it  is  with  children  ;  a  lack  of  obedience  will  but  lead  to  a  laying 
up  of  trouble  in  the  future  for  parent  and  child.  Many  children  and 
adults  possess  a  certain  physical  courage  and  are  yet  lacking  on  the 
moral  side.  It  is  this  moral  courage  that  is  oftentimes  among  the  most 
beautiful  of  the  traits  of  humanity,  and  where  acquired  in  early  youth 
becomes  as  a  golden  skein  running  through  the  individual's  entire  life. 

Self-confidence  and  decision  of  character  mark  the  difference  be- 
tween the  real  man  or  woman  and  the  vacillating  weakling.  To  be 
able  to  reach  a  prompt  and  early  decision  and  strictly  follow  out  the 
lines  decided  upon  without  "post-morteming"  every  result  decided, 
will  unquestionably  have  a  tendency  to  lengthen  life  and  make  it  more 
happy,  for  there  are  hundreds  of  neurotics  who  are  literally  torn 
to  tatters  by  deciding  and  reconsidering  decisions,  reopening  settled 
questions  until  they  almost  reach  a  state  of  morbid  doubt.  The  prompt 
and  definite  decision,  even  though  adverse,  is  better  than  the  decision 
that  it  is  known  can  be  easily  unsettled. 

Bad  habits,  mental,  moral,  bodily  and  sexual,  must  be  closely 
watched  and  promptly  overcome  by  explanation,  precept,  suggestion 
and  example,  and  this  would  include  the  necessity  for  eradicating 
.such  habits  as  nail  biting,  grimaces,  blinking  and  others  of  a  far  more 
serious  nature.  While  many  of  these  habits  are  not  of  themselves 
injurious,  still  they  present,  from  an  esthetic  standpoint,  objectionable 
features  and  tend  to  mar  the  child's  composure.  Their  restraint  is 
doubly  valuable  and  desirable,  for  with  it  must  come  strengthening 
of  the  will,  and  in  this  way  better  control  secured  through  inhibition 
processes.  The  habit  of  unsociability  is  to  be  promptly  squelched, 
and  the  child  and  youth  taught  that  human  beings  are  naturally  asso- 
ciative animals,  and  that  all  through  life  companionship  of  our  fel- 
lows is  necessary  to  our  existence  and  happiness,  and  that  where  we 


REARING  OF  THE  DELICATE  CHILD.  501 

refuse  to  associate  we  arc  laying  up  potent  opportunities  for  personal 
unhappiness. 

A  certain  appreciation  of  one's  value  is  not  bad,  but  overhearing 
egotism  is  unendurable  in  any  one.  No  man  has  accomplished  so 
much  in  his  short  span  of  three-score  years  and  ten  that  he  can  permit 
himself  to  believe  that  his  hat-band  has  increased  several  sizes.  We 
should  remember  that  Newton,  the  discoverer  of  gravitation,  said 
he  felt  he  had  only  "wandered  down  to  the  sea  of  knowledge  and 
picked  up  a  few  pebbles  from  the  beach." 

To  be  the  focus  of  every  thought  within  the  household,  to  be  the 
pivotal  center  from  which  all  ideas  radiate  and  from  which  all  move- 
ments turn,  is  a  position  for  a  youngster  that  is  positively  certain  to 
develop  in  him  a  distorted  view  of  himself  and  things  in  general  about 
him.  A  dangerous  foe  to  these  children  is  worry,  which,  terrible 
enough  in  adults,  is  simply  indescribable  in  the  child;  the  formation 
of  such  a  habit  exhausts  physical  and  nervous  reserve  forces;  the 
chafing  against  useless  and  needless  things  is  bound  to  develop  a 
selfishness  and  capriciousness  that  is  hard  to  eradicate.  Unless 
early  control  is  exercised  and  that  noblest  of  all  desires,  to  do  for  and 
help  others,  carefully  taught,  he  will  become  in  later  years  a  menace 
to  himself  and  hopelessly  disagreeable  to  those  with  whom  he  is  asso- 
ciating. 

Early  in  life  children  should  be  taught  the  necessity  of  labor;  it 
is  the  heritage  of  men  and  women.  Says  Patrick:  "Labor  may  have 
been  a  calamity  for  Adam  and  Eve.  Nowadays  it  is  no  curse,  but  the 
bright,  true  star  of  health  and  happiness.  To  work  with  enthusiasm 
is  to  form  the"  very  essence  of  a  vigorous  existence."  No  one  knows 
better  than  the  physician  of  long  experience  that  many  a  man  and 
many  a  woman  would  be  a  great  deal  better  if  some  consuming  occu- 
pation took  their  time.  Labor  in  a  child  of  tender  years  may  be  en- 
compassed under  the  word  play,  and  we  should  urge  that  boys  and 
girls  play  hard,  especially  delicate  ones;  let  them  get  tired,  let  them 
rest,  for  after  all  the  child  should  be  a  great  deal  of  the  animal ;  eat, 
play  and  sleep.  It  can  be  said  of  the  human  frame  that  it  was  con- 
stituted for  work  and  play,  and  a  failure  to  follow  out  the  ordained 
lines  of  physiology  is  to  cultivate  its  shady  side — pathology. 

In  the  management  of  these  children  idealism  would  place  them 
in  the  country,  with  plenty  of  fresh  air  and  all  the  incentives  that 
come  from  fresh  fields,  pastures  green,  birds  and  babbling  brooks — 
in  fact,  a  place  where  the  human  being  can  come  in  close  contact 
with  his  Maker.  Sturdy  companions  the  child  should  find,  whose 
healthy  exuberance  and  active  play  make  the  day  seem  short  and  pleas- 
ant; books  and  studies  to  form  a  secondary  part  of  the  training  and 
to  be  of  practical  character;  not  too  much  morals  and  not  too  much 
religion.     A  remark  of  this  kind  is  always  misinterpreted.     I  would 


502  PRACTICAL  HYDROTHERAPY. 

state  that  the  growing  mind  should  be  taught  beautiful  thoughts  and 
living,  the  facts  of  true  religion,  and  not  be  threatened,  tired  or  bored 
with  flaming  ideas  of  eternal  damnation. 

The  diet  should  be  mixed,  abundant,  and  consist  of  cereals,  fruits, 
carbohydrates,  vegetables  and  a  moderate  amount  of  meat.  Three 
meals  a  day,  supplemented,  if  necessary,  by  an  occasional  lunch,  will 
help  the  child  to  a  better  nutrition  and  to  take  on  flesh. 

It  is  a  natural  thing  for  children  under  puberty  to  be  little  pigs, 
and  it  should  be  rememebred  that  little  pigs  are  frequently  fed,  and 
tins  may  account  for  their  usual  roly-poly  appearance.  Children  are 
to  be  given  as  few  drugs  as  possible,  opiates  rarely,  and  alcohol  never. 
The  idea  of  permitting  a  child  to  be  "finicky"  in  his  likes  and  dislikes 
for  food  placed  upon  the  table  is  out  of  the  question.  Children  should 
be  made  to  eat  someting  of  everything  that  is  known  to  be  beneficial, 
and  in  that  way  cultivate  a  reasonable  and  rational  appetite  and  liking 
for  food. 

Nothing  less  than  ten,  and,  better,  twelve,  hours'  sleep  should  be 
exacted  from  the  growing  child,  and  ten  hours  would  be  an  excellent 
allowance  for  some  of  the  youths  just  over  puberty,  who  begin  to  think 
that  they  know  more  than  their  elders  as  to  what  is  good  for  them. 
They  should  sleep  upon  hard  mattresses  and  in  well-ventilated  rooms. 

Taken  as  a  whole,  the  girl  suffers  more  than  the  boy  from  the  re- 
straint that  her  elders  exercise  in  her  control.  When  she  feels  the 
necessity  of  running  off  some  of  her  superfluous  energy  she  is  told 
that  such  actions  are  awkward  and  ungraceful,  and  is  ordered  to  sit 
quietly,  properly  and  primly  in  a  chair,  with  her  hands  folded  in  her 
lap  "like  a  perfect  lady,"  and  it  is  probably  due  to  some  of  this  train- 
ing that  we  to-day  find  so  many  delicate,  neuropathic  women.  It 
is  certainly  a  great  factor  in  making  the  female  sex  much  more  emo- 
tional than  the  male.  Per  contra,  if  the  boy  desires  to  let  loose  any 
superfluous  energy  he  may  have,  he  is  ordered  out  of  sight  and  told 
not  to  annoy  his  male  or  female  elders,  and  finds  relief  in  the  active 
companionship  of  his  friends  and  comrades.  This  is  kept  up  more  or 
less  during  the  entire  life  of  the  two  sexes. 

Tt  is  the  author's  opinion  that  of  all  the  factors  that  go  to  make 
up  the  management  of  the  rearing  of  these  children  hydrotherapy  is 
by  far  the  most  important.  Its  powerful  tonic  effect,  its  anesthetic 
influence  upon  the  nervous  system,  its  action  upon  digestion,  assim- 
ilation, elimination  and  growth,  mental,  moral  and  physical,  is  un- 
questioned and  powerful.  A  question  recently  addressed  to  a  cham- 
pion pugilist  as  to  what  he  considered  the  one  thing  that  prevented 
him  suffering  pain  from  the  blows  of  his  adversary,  was  instantly 
answered  as  "cold  water,"  and  the  explanation  that  followed  was  the 
layman's  explanation  of  the  physiological  action  of  cold  water  upon 
the  organism.      Children    from   early  life   should  be  taught   to  stand 


REARING  OF  THE  DELICATE  CHILD.  503 

any  quantity  of  very  cold  water,  and  made  to  acquire  the  habit  of 
taking  cold  baths. 

These  children  should  be  reared  by  parents  who  are  constantly 
instructed  by  the  physician  concerning  the  measures  they  should  adopt 
with  a  view  of  meeting  the  conditions  present  in  the  child's  particular 
ease.  All  treatment  must  in  the  end  be  based  upon  the  age,  constitu- 
tion and  reactive  capacity  of  the  particular  child,  after  a  most  careful 
consideration  of  all  the  facts  of  the  case,  supplemented  by  a  careful 
physical  examination.  Children  under  hydriatics  should  begin  to  re- 
spond within  two  weeks,  but  where  colds,  sore  throat,  loss  of  appe- 
tite, insomnia,  mental  irritability  and  acute  intestinal  affections  make 
their  appearance,  it  is  an  intimation  of  the  failure  of  the  hydriatist 
to  adopt  proper  measures,  a  too  rapid  change  in  temperature,  or  a 
poor  reaction. 

The  infant  must  be  bathed  with  a  due  regard  to  the  sensitiveness 
of  its  tender  tissues  and  kept  warm  at  all  times.  During  the  latter 
months  of  the  first  year  the  warm  cleansing  bath  may  be  followed  by 
a  tepid  or  cool  sponge  at  85°  to  80°  F.,  rapidly  performed,  the  bath 
being  terminated  by  friction  with  the  hand ;  it  is  a  useful  method. 
When  the  infant  is  a  year  old  we  may  commence  the  use  of  stimu- 
lating cold  measures,  provided  we  secure  tonic  reaction ;  these  meas- 
ures should  be  kept  up  for  the  rest  of  the  individual's  life.  Just  be- 
cause cold  water  is  used  does  not  prevent  one  being  sensible  and 
judicious  in  not  exposing  their  children  to  inclement  weather.  A 
little  admixture  of  brains  with  hydrotherapy  is  oftentimes  a  useful 
combination.  The  application  should  be  made  once  daily  in  a  warm 
room  on  arising,  best,  however,  at  bedtime.  The  following  plan  will 
be  found  most  excellent  for  young  children  who  are  growing  up,  or 
for  those  whom  we  are  commencing  to  train  to  stand  tonic  cold  appli- 
cations:  Commence  with  the  cold  sponge  at  90°  F.,  followed  by  a 
rapid  drying  with  a  rough  towel  until  the  skin  "pinks."  Reduce  the 
temperature  one  degree  daily  until  75°  F.  is  reached;  a  brief  oil  rub 
will  be  found  a  valuable  addition,  especially  in  infants  and  children 
who  are  much  run  down  in  health.  When  they  begin  to  react,  use 
the  warm  full  bath  at  100°  to  102°  F.  three  times  weekly,  followed 
by  the  cold  sponge  at  60°  F.,  rapidly  performed,  the  whole  being 
terminated  with  friction  from  a  crash  towel.  Three  times  a  week 
soap  may  be  employed  with  advantage  immediately  after  immersion 
in  the  warm  bath. 

As  the  child  grows  and  develops,  or  as  reaction  is  established,  the 
use  of  the  salt  rub,  followed  by  the  full  warm  bath  and  cold  shower 
at  70°  to  60°  F.,  will  be  found  to  be  one  of  the  best  home  measures 
that  can  be  employed  in  these  cases.  Where  the  shower  cannot  be 
obtained,  the  affusion  to  the  chest,  back  and  spine,  while  sitting  in 
about  four  inches  of  warm  water,  may  be  used  as  a  substitute. 


504  PRACTICAL  HYDROTHERAPY. 

The  author  is  again  constrained  to  remark  that  a  shower  bath 
in  a  home  where  there  are  growing  children  is  of  far  greater  use  and 
importance  than  many  pieces  of  vertu  or  bric-a-brac.  That  it  is  im- 
perative in  those  families  that  have  delicate,  tubercular  and  neuro- 
pathic children,  goes  without  saying.  Its  use  is  equally  applicable 
to  girls  and  boys,  and  will  insure  good  health  to  children,  youths  and 
adults,  more  so  than  any  other  known  procedure  in  the  broad  field  of 
therapeutics.  It  is  especially  to  be  recommended  to  girls,  and  where 
its  vasomotor  tonic  influence  is  early  established  there  is  no  rhyme 
or  reason  why  the  girl  should  discontinue  the  daily  use  of  such  a  bath 
after  the  establishment  or  even  during  the  menstrual  flow.  When 
the  present  lack  of  intelligence  regarding  the  value  of  cold  water  as 
a  tonic  reconstructor  has  been  overcome  we  may  begin  to  hope  that 
the  American  nation  will  take  steps  forward  in  the  prevention  of  these 
pitiable  cases.  The  cold  plunge  may  be  employed  at  60°  to  65°  F., 
but  it  does  not  in  any  sense  exercise  the  same  beneficial  influence  as 
the  shower.     It  is  too  much  of  a  shock.     , 

In  summer  both  sexes  should  be  urged  to  swim,  as  we  have  in  this 
method  a  combination  of  active  exercise  with  tonic  effects  of  the  cold 
water  upon  the  periphery.  Surf  bathing  is  most  excellent,  and  many 
a  delicate  child  has  had  the  foundation  and  betterment  of  health  to 
date  from  a  visit  to  the  seashore.  The  use  of  cold  surf  bathing,  with 
its  attendant  pleasures,  should  be  allowed  with  due  regard  to  the  rules 
that  have  been  previously  laid  clown.  In  cities  this  treatment  is  even 
more  necessary,  and  is  to  be  supplemented  by  instruction  in  gymnastics 
and  exercises  under  some  competent  instructor.  All  exercises  are  to 
be  followed  by  the  warm  cleansing  bath  or  warm  shower,  and  this 
by  the  cold  shower  or  rain  bath  where  accessible.  Many  individuals 
soon  learn  to  stand  temperatures  as  low  as  40°  or  50°  F.,  and  though 
the  application  is  for  the  second  disagreeable,  the  after-effects  are  so 
pleasant,  the  exuberance  so  delightful,  that  they  continue  its  use  as 
a  method  of  health-preservation. 

In  conclusion,  it  may  be  said  that  through  the  use  of  tonic  hydro 
therapy   the   mental,   moral   and   psychical   fiber   is   strengthened   and 
toughened,  to  resist  the  encroachments  of  passion  and  disease. 


CHAPTER  XXIII. 
DISEASES  OF  WOMEN. 

Vulvitis. 

Vulvitis  is  an  inflammation  of  the  vulva,  and  may  be  simple,  puru- 
lent or  follicular.  Simple  vulvitis  originates  for  the  most  part  as  a 
result  of  local  irritation  or  tilth,  from  acrid  discharges  from  the  uterus 
and  vagina,  from  decomposing  secretions,  from  friction,  scratching, 
and  as  a  result  of  masturbation.  Purulent  vulvitis  is  usually  the  result 
of  gonorrheal  infection  or  a  simple  vulvitis  that  has  become  infected. 
Erosion  or  ulceration  are  not  uncommon  results.  The  perineum  and 
inner  surfaces  of  the  thighs  may  participate  in  the  inflammation  and 
become  excoriated.  The  follicles  become  involved  in  the  follicular 
variety.  It  occurs  sometimes  in  girls  and  young  children,  especially 
where  they  are  much  run  down. 

The  first  element  in  the  treatment  of  this  condition  is  the  estab- 
lishment of  absolute  local  cleanliness,  which  should  be  followed 
by  the  use  of  the  hot  vaginal  douche,  using  an  alkaline  antiseptic, 
bichloride  or  permanganate  of  potassium  solution.  Where  the  in- 
flammation is  excessive  and  the  parts  hot  and  feverish,  we  may  apply 
the  continuous  cold-water  coil  or  Leiter's  tubes  molded  to  the  parts. 
Rectal  irrigation  with  hot  saline  will  sometimes  do  much  to  relieve 
local  distress.  The  most  satisfactory  hydrotherapeutic  application  is 
the  hot  sitz  bath  at  104°  to  110°,  even  115°  F.  if  possible,  for  ten 
minutes,  repeated  three  or  four  times  during  the  twenty-four  hours. 
An  excellent  scheme  of  treatment  is  to  use  the  sitz  bath,  followed  by 
the  vaginal  douche,  drying  the  parts  and  dressing  them  with  zinc 
stearate.     Keep  the  parts  separated  by  the  use  of  dry  gauze  pledgets.. 

Pruritus  Vulvae. 

This  is  an  itching  of  the  vulva,  usually  unattended  with  any  ap- 
parent definite  lesion.  The  most  common  causes  are  acrid  discharges 
from  the  uterus  and  vagina,  from  acid  or  diabetic  urine,  pelvic  in- 
flammation, ill-fitting  clothes,  habitual  constipation,  masturbation, 
excessive  venery,  reflex  nervous  influences,  etc.  It  may  become  so 
severe  as  to  cause  the  sufferer  to  become  a  recluse  from  society. 
Scratching  may  increase  irritation  and  cause  abrasions,  with  subse- 
quent infection.  It  is  aggravated  by  over-exercise,  stimulants,  over- 
eating, warmth  of  the  bed  and  over-sexual  indulgence.  It  may  cause 
(505) 


506  PRACTICAL  HYDROTHERAPY. 

loss  of  sleep,  appetite  and  strength  until  the  health  becomes  under- 
mined. Some  cases  become  so  morbid  as  to  deprive  the  Unfortunate 
woman  of  her  mental  balance. 

If  any  causal  factor  can  be  found,  remove  this  at  once. 
While  we  are  using  local  measures,  general  tonic  hydrotherapy  and 
the  relief  of  any  underlying  pathological  condition  should  be  at  once 
instituted.  We  may  commence  with  the  electric  light  bath  to  free 
perspiration,  followed  by  the  horizontal  rain  bath  at  a  tempera- 
ture of  104°  F.  for  one  minute,  reduced  to  80°  F.  for  one-fourth 
minute,  pressure  twenty  pounds.  Give  the  treatment  daily,  decreasing 
the  temperature  two  degrees  until  65°  F.  is  reached  and  increase  the 
pressure  one  pound  until  thirty  is  registered.  This  may  be  followed 
by  the  use  of  the  perineal  douche  at  60°  to  50°  F.  for  one-fourth  to 
one-half  minute,  pressure  bearable.  Should  any  discharges  from  the 
uterus  be  present  they  are  best  met  by  the  use  of  hot  vaginal  douches 
of  bichloride  ( 1  :2000)  or  hot  potassium  permanganate  ( 1 :1000  or 
1:500).  The  douche  should  be  taken  in  the  dorsal  position  in  order 
that  the  rugae  may  become  distended  and  to  prevent  the  secretion  from 
reaching  the  vulva  and  external  surfaces.  Tampon  the  vagina  with 
gauze  wet  in  some  alkaline  antiseptic  solution,  on  the  top  of  which,  at 
the  entrance,  place  a  plug  of  cotton.  This  dressing  should  remain  in 
for  twelve  hours.  Sometimes  it  is  not  the  quantity  but  the  acridity 
of  the  secretion  that  causes  the  trouble.  The  hot  sitz  bath  at  105°  to 
110°  F.,  duration  ten  minutes,  is  an  excellent  method  of  relieving 
intense  irritation.  Where  this  cannot  be  followed  out  the  fomentation 
at  120°  to  130°  F.  for  five  to  ten  minutes,  repeated,  will  be  found 
serviceable.  The  prolonged  neutral  sitz  bath  at  94°  to  92°  F.  for 
twenty  minutes  will  oftentimes  give  relief  when  all  ether  measures 
fail.  An  excellent  plan  to  pursue  is  the  following:  Morning  and 
night,  vaginal  antiseptic  douche,  followed  by  the  hot  sitz  and  tampon ; 
during  the  middle  of  the  day  general  tonic  hydrotherapy.  Zinc  stearate 
with  ichthyol  is  an  excellent  dressing  to  be  used  in  these  cases. 

Vaginismus  and  Vulvo-Vaginal  Hyperesthesia. 

These  conditions  are  the  same  in  origin  and  essential  features. 
In  vulvo-vaginal  hyperesthesia  there  is  extreme  sensitiveness  of  the 
introitus  vaginae  and  contiguous  parts,  while  in  vaginismus  there  is 
superadded  powerful  contractions  of  the  constrictor  cuni  muscles  when 
the  parts  are  touched.  It  occurs  most  frequently  in  young  recently 
married  women.  These  cases  vary  in  intensity,  and  may  form  a  barrier 
to  or  make  sexual  relations  painful.  It  is  a  neurosis,  usually  dependent 
upon  local  conditions,  but  often  having  a  constitutional  background. 
Inflammation,  cicatrical  contraction,  with  or  without  erosions,  are  the 
most  constant  local  causes.  Many  cases  occur  in  neurotics.  Rectal 
diseases,  especially  fissure  or  fistula,  may  cause  it. 


DISEASES  OF  WOMEN.  507 

Treatment  should  be  both  general  and  local.  The  general  treat- 
ment consists  of  the  electric  light  hath,  superheated  dry  hot  air  hody 
apparatus  or  the  hot-air  hath  to  the  point  of  free  perspiration,  unless 
the  patient  is  thin  and  anemic,  in  which  event  it  should  he  stopped 
just  short  of  sensible  moisture.  This  should  be  followed  by  the 
horizontal  rain  bath  at  100°  to  102°  F.  for  one  to  two  minutes,  re- 
duced to  80°  F.  for  one-fourth  minute,  pressure  twenty  pounds; 
reduce  the  temperature  two  degrees  daily  to  60°  F.  and  increase  the 
pressure  one  pound  until  thirty  pounds  is  registered.  This  bath 
should  be  immediately  followed  by  the  hot  .sitz  at  105°  to  110°  F.,  or 
even  115°,  for  fifteen  minutes.  Commence  with  105  and  rapidly  add 
hot  water  until  the  highest  possible  temperature  is  reached.  As  soon 
as  the  patient  can  stand  the  treatment  the  jet  douche  should  be  insti- 
tuted, and  to  this  end  we  may  give  the  following:  Electric  light  bath 
to  perspiration,  followed  by  the  horizontal  rain  bath  at  100°  F.  for 
one  minute,  pressure  twenty-five  to  thirty  pounds ;  this  in  its  turn  to 
be  followed  by  the  jet  douche  to  the  spine  at  110°  to  120°  F.  if 
possible,  pressure  twenty-five  pounds,  reduced  to  75°  F.,  same  pressure. 
Following  this  somewhat  vigorous  treatment  we  may  select  the  appli- 
cation of  the  hot  sitz  or  a  very  hot  perineal  douche  for  a  half  to  one 
minute  at  the  same  temperatures. 

The  local  treatment  embraces  the  use  of  gradual  dilatation,  com- 
mencing digitally,  until  the  smallest  size  of  the  self-retaining  rectal 
dilators  can  be  used.  When  this  point  is  reached  the  patient  is  to  be 
instructed  to  use  the  dilator  for  several  hours  daily.  Constipation 
must  be  looked  after  and  sexual  abstinence  insisted  upon. 

Vaginitis. 

Vaginitis  is  an  inflammation  of  the  vagina,  either  acute  or  chronic. 
Its  origin  is  most  frequently  microbic,  but  it  may  be  caused  by  injury, 
acrid  uterine  discharges,  strong  chemicals,  etc.  The  pavement  epi- 
thelium of  the  vagina  is  hard,  dense,  resistant,  and  under  ordinary 
circumstances  a  protective  against  germ  infection,  save  to  the  gono- 
coccus  of  Neisser,  which  is  by  far  the  most  frequent  provocative. 
This  infection  is  more  active  where  the  epithelium  has  been  previously 
macerated  by  leucorrheal  discharges.  Its  pathology  is  essentially  that 
of  a  surface  inflammation,  microbic  in  character. 

The  essential  treatment  in  the  management  of  this  troublesome 
affection  is  to  remove  irritation,  secure  cleanliness,  relieve  congestion 
and  secure  rest.  The  first  step  should  be  the  administration  of  a 
large  dose  of  calomel,  followed  by  a  saline  and  hot  enema  next  day. 
The  bowel  after'this  should  be  kept  freely  open.  Give  the  hot  vaginal 
douche  with  potassium  permanganate  (1:500)  morning  and  night, 
with  the  patient  in  a  dorsal  position;  administer  three  or  four  douches 
between  times  of  hot  normal  saline  solution,  followed  in  each  instance 


508  PRACTICAL  HYDROTHERAPY. 

by  the  hot  sitz  bath  at  105°  to  115°  F.  for  ten  to  fifteen  minutes.  The 
usual  result  is  a  very  prompt  subsidence  of  the  inflammation.  When 
this  has  taken  place  a  more  or  less  chronic  inflammation  remains, 
which,  in  the  author's  experience,  has  proven  rather  tenacious.  In 
order  to  bring  about  a  cure  the  following  method  has  been  found  most 
satisfactory:  After  securing  complete  functional  rest  of  the  parts,  the 
uterus  is  treated  for  any  existing  disease  and  the  patient  given  night 
and  morning  the  hot  vaginal  douche,  105°  to  115°  F.,  in  a  dorsal  posi- 
tion, followed  by  the  hot  sitz  bath  at  105°  to  110°  F.  for  ten  minutes. 
With  improvement  this  treatment  becomes  necessary  but  once  daily. 
The  vagina  should  be  packed  loosely  with  gauze  wet  with  an  alkaline 
antiseptic,  and  any  abraded  or  ulcerated  surfaces  touched  with  car- 
bolic acid  (10  per  cent.)  or  argyrol  in  glycerine  (25  per  cent.). 

General  tonic  measures  are  necessary  for  the  permanent  restora- 
tion to  health,  and  nothing  equals  the  electric  light  bath  to  point  of 
free  perspiration,  followed  by  the  horizontal  rain  bath  at  102°  to  103° 
F.  for  one  minute,  reduced  to  65°  F.,  pressure  twenty-five  pounds, 
followed  by  a  cold  sitz  bath  at  60°  F.  for  two  to  five  minutes.  Any 
existing  complications  should  be  met. 

Amenorrhea. 

Amenorrhea  may  be  defined  as  an  irregularly  appearing,  deficient 
or  suppressed  menstrual  flow.  This  condition  is  by  long  odds  most 
frequent  in  young  girls  just  entering  the  stage  of  puberty  or  during 
their  early  womanhood.  It  may  be  stated  as  almost  axiomatic  that 
wherever  we  have  this  function  affected  general  disturbed  conditions 
are  always  associated  with  it  which  demand  attention. 

In  girls  who  are  frail  and  weak,  who  have  impaired  general  health, 
and  in  whom  the  menstruations  appear  scanty,  we  may  expect  the 
varying  disturbances  associated  with  a  partial  or  total  disappearance 
of  the  flow  ;  but  in  these  cases  we  should  be  most  particular  and  ex- 
haustive in  our  examination  of  the  general  condition,  for  at  this  age 
tubercular  trouble  most  frequently  makes  its  appearance.  Where 
tubercular  conditions  exist  the  failure  of  the  menstrual  flow  is  a 
valuable  asset  to  the  patient,  for  Nature,  in  her  conservative  and  pre- 
servative ways,  is  husbanding  all  the  strength,  vitality  and  blood  that 
the  individual  possesses  to  fight  the  disease. 

The  most  frequently  associated  condition  is  probably  anemia  or 
chlorosis.  The  appearance  of  the  girl  or  woman  indicates  or  suggests 
the  condition  that  is  present,  for  the  skin  is  likely  to  be  of  a  pale 
sallow  or  grayish-green  color,  with  a  tendency  toward  scaliness,  dry- 
ness and  harshness.  These  girls  are  especially  prone -to  develop  a  dry, 
harsh  skin  of  the  body  and  a  greasy  and  pimply  condition  of  the  face, 
the  acne  being  of  the  small  pustular  variety,  with  rather  hard  bases. 
Often   we   find   the   presence   of   a   marked   digestive   disorder.        No 


DISEASES  OF  WOMEN.  509 

doubt  this  is  duo  to  the  fact  that  young  people  at  the  time  of  puberty 
pay  very  little  attention  to  the  proper  and  careful  mastication  of  their 
food.  Not  only  is  it  essentia]  that  food  should  be  well  subdivided  by 
proper  chewing,  but  that  the  saliva  be  carefully  and  thoroughly  incor- 
porated in  the  bolus  before  swallowing.  Girls  and  boys  gorge  them- 
selves with  improper  food,  poorly  masticated,  and  trust  to  the  strength 
of  youthful  digestive  organs  to  overcome  their  carelessness.  It  is 
not  astonishing  that  these  girls  develop  a  sallow  and  disordered  skin, 
and  an  over-abundance  of  "nerves."  Overstudy  and  strain  starve  the 
generative  organs  both  of  nerve  force  and  the  circulation  needed  for 
their  proper  development  and  normal  action.  The  large  quantity 
of  nerve  force  that  is  normally  required  for  the  sexual  organs  is 
denied  them,  wasted  in  studies  that  are  often  of  no  real  practical 
value. 

Studies  should  have  for  their  object  the  training  of  the  mind  and 
not  the  mere  acquirement  of  knowledge ;  a  little  study  well  applied  to 
the  development  of  brain  capacity,  without  robbing  any  of  the  vital 
organs,  is  indeed  a  rarity.  There  is  an  intimate  and  close  relation 
between  the  nervous  system  and  relief  to  nerve  tension  in  the  normal 
performance  of  the  menstrual  function. 

There  is,  however,  another  type — a  girl  in  whom  amenorrhea  may 
occur,  she  being  to  all  appearance  strong  and  robust,  with  fair  or 
excellent  development  of  hip  and  bust,  and  in  these  cases  we  may 
almost  certainly  count  that  the  failure  to  properly  perform  this 
function  is  due  to  some  nervous  element.  With  the  menses  stopped 
they  begin  to  worry,  because  they  know  something  is  wrong;  this 
simply  adds  fuel  to  the  flame,  making  matters  worse  and  retarding 
recovery.  A  little  persuasive  psychology  will  often  do  ?s  much  toward 
relieving  the  primary  causes  as  well-applied  treatment. 

Where  the  condition  occurs  in  a  female  who  has  married  we  can 
look  usually  to  one  of  two  conditions.  We  will  find  that  the  flow  is 
usually  diminished  or  scanty,  rather  than  that  it  is  completely  stopped. 
In  the  first  class  is  the  anemic,  neurotic,  overworked  and  toxic  woman, 
in  whom  the  conditions  are  similar  to  those  enumerated  above.  The 
other  type  or  class,  however,  is  distinctive,  and  gives  the  history  of 
having  married  and  rapidly  gained  flesh — in  fact,  has  become  overly 
stout,  although  a  test  of  the  blood  will  show  that  she  is  a  "fat  anemic." 
They  are  usually  sterile,  have  no  children  or  work  to  engross  their 
attention,  lead  an  indolent,  novel-reading  life,  and  present  the  dull, 
listless  "tired-all-the-time"  woman.  Local  examination  shows  the 
cervix  to  be  congested  and  the  entire  musculature  and  circulation  of 
the  pelvis  to  be  weak. 

The  diagnosis  is  usually  quite  clear  in  married  women  where  a 
full  and  thorough  local  examination  can  be  made,  and  the  conditions 
there  found  will  clearly  point  out  the  line  of  treatment  to  be  adopted. 


510  PRACTICAL    HYDROTHERAPY. 

When  the  girl  is  of  sufficient  age,  though  backward  in  development, 
is  small  in  stature  and  thin,  where  the  breasts  are  flat,  the  thighs 
small  and  the  general  contour  indicative  of  improper  filling,  we  may 
reasonably  expect  an  infantile  uterus  and  pelvic  organs.  This  condi- 
tion demands  urgent  and  immediate  attention,  and  no  false  modesty 
should  prevent  the  physician  from  plainly  laying  before  the  family 
the  prospect  of  imperfect  growth  and  sterile  womanhood,  with  ac- 
companying unhappiness  if  the  girl  enters  the  marital  state.  Parents, 
as  a  rule,  when  this  matter  is  properly  and  delicately  broached,  are 
willing  that  the  examination  be  made,  and,  in  my  opinion,  when  once 
attempted,  must  be  thorough  and  painstaking.  We  will,  as  a  rule, 
find  that  the  labia  are  narrow  and  thin,  that  the  perineum  and  vagina 
are  short,  that  the  uterus  is  small,  undeveloped  or  infantile  in  size, 
and  the  ovaries  difficult  to  detect. 

Hygienic  rules  should  be  instituted  and  the  patient  made  to 
retire  early,  obtaining  as  much  sleep  as  possible.  It  i  is  preferable 
that  the  mattress  be  firm  and  the  bolster  or  pillow  not  too  high. 
She  should  learn  to  sleep  upon  the  side,  not  upon  the  back  or  abdo- 
men. Over-study  is  to  be  prevented,  and  recreation  in  the  fresh  air 
sought.  Pleasant  companions  of  her  own  age  and  sex  aid  in  recovery. 
Society,  parties,  late  hours  and  all  forms  of  excitement  are  to  be  for- 
bidden. 

The  diet  should  be  plain,  with  a  small  amount  of  meat,  plenty  of 
milk,  vegetables,  butter,  few  sweets ;  no  pickles,  pastries  or  eating 
between  meals. 

Hydrotherapy  is  probably  enough  in  itself  to  bring  about  resto- 
ration of  health,  owing  to  its  tonic,  stimulant,  reconstructive  and 
nerve-sedative  properties.  The  patient  must  be  gradually  trained  to 
stand  cold  water.  We  may  commence  with  the  electric  light  bath  or 
hot-air  bath  to  point  of  perspiration,  and  follow  this,  in  very  delicate 
cases,  with  the  rapid  cold  sponge  or  the  dripping  sheet  at  80°  F.  for 
three  minutes,  reduced  two  degrees  daily  to  65°  F.  This  will  grad- 
ually establish  reaction,  and  we  may  then  proceed  to  the  electric 
light  bath  to  free  perspiration,  followed  by  the  horizontal  rain  bath 
at  100°  to  102°  F.  for  one  minute,  reduced  to  65°  F.  for  one-fourth 
minute,  pressure  twenty-five  pounds.  This  may  be  followed  by  the 
very  brief  cold  sitz  bath  (55°  to  65°  F.)  for  two  or  three  minutes. 
The  direct  and  reflex  influence  of  this  last  procedure  is  to  materially 
increase  pelvic  circulation.  A  most  satisfactory  application  in  cases 
that  are  fairly  robust,  and  who  have  been  trained  to  the  treatment, 
is  the  application  of  the  Scottish  douche.  Give  the  following:  Elec- 
tric light  bath  to  free  perspiration,  followed  by  the  Scottish  jet  douche 
to  the  spine  at  105°  to  110°  F.  for  fifteen  seconds,  alternating  with 
the  cold  jet  at  70°  to  50°  F.,  applied  to  the  lower  spine,  hypogastrium 
and  inner  surface  of  thighs,  for  ten  seconds,  pressure  twenty  pounds, 


DISEASES  OF  WOMEN.  511 

this  treatment  to  be  fell. .wed  by  the  sitz  bath  above  referred  to. 
Endeavors  should  be  made  to  relieve  the  anemia,  chlorosis,  digestive 
disturbances,  constipation,  malaria,  etc.  The  author  has  demonstrated 
frequently  the  fact  that  Chapman's  ice-bag  or  an  ice-compress  applied 
to  the  lower  spine  will  have  a  most  beneficial  influence  in  heightening 
the  pelvic  circulation  and  bringing  about  an  increased  flow.  The  wet 
half  pack  or  trunk  compress  applied  to  the  pelvic  region  and  hips 
at  60°  F.  for  twenty  minutes  acts  in  a  similar  manner.  Daily  or  twice 
daily  use  of  the  hot  vaginal  douche  at  120°  F.,  three  to  four  quarts, 
will  tend  to  improve  the  vascular  activity  of  the  organs.  At  the  time  of 
the  menstrual  flow  endeavors  must  be  made  to  concentrate  the  circu- 
lation within  the  pelvic  organs,  and  to  this  end  we  employ  a  number 
of  methods,  the  simplest  of  which  is  the  vaginal  douche  at  100°  to 
102°  F.  night  and  morning,  followed  by  the  fomentation  or  hot  pack 
to  the  pelvic  region  for  twenty  to  thirty  minutes,  or  the  hot  sitz 
bath  or  the  hot  half  bath  at  105°  to  110°  F.  for  ten  to  fifteen  minutes. 
It  should  be  borne  in  mind  that  very  hot  vaginal  douches  check  the 
flow,  while  those  at  the  temperature  named  tend  to  produce  bleeding. 

These  cases  are  frequent,  and  can,  in  the  vast  majority  of  instances, 
be  radically  and  certainly  relieved  by  hydrotherapy,  the  simplicity  of 
which  places  it  within  the  range  of  every  physician's  practice.  It  is 
surprising  that  this  method  is  so  little  utilized. 

Dysmenorrhea. 

Normal  menstruation  is  unattended  with  pain  or  discomfort  of 
any  kind,  and  this  is  true  of  all  the  functions.  During  the  process 
the  mucous  membrane  lining  the  uterus  shreds  and  disintegrates,  and 
should  be  passed  through  the  cervical  canal  without  pain.  Dysmen- 
orrhea is  difficult  or  painful  menstruation,  and  is  no  longer  considered 
a  pathological  entity,  but  a  symptom  secondary  to  other  conditions, 
and  this  is  true  in  practically  every  case.  I  know  of  no  condition 
so  often  associated  with  other  pelvic  diseases  as  this.  We  have,  as 
a  rule,  more  than  one  disturbing  element. 

Dysmenorrhea  may  be  classified  under  three  heads: 

1.  A  constitutional  and  neurotic  class,  having  the  origin  of  their 
pain  outside  of  the  pelvis  and  dependent  upon  general  conditions. 
In  this  class  we  find  the  neurotic,  neurasthenic,  rheumatic,  gouty,  ma- 
larial, anemic  and  gastro-intestinal  individual. 

2.  A  secondary  or  inflammatory  class,  in  which  the  pain  originates 
and  is  secondary  to  other  conditions  in  the  pelvis,  the  principal  cause 
of  which  is  endometritis. 

3.  A  stenotic  or  obstructive  class,  the  pain  of  which,  in  my  opinion, 
being  due  to  an  actual  narrowing  or  obstruction  of  the  canal.  The 
majority  of  women  who  suffer  from  this  trouble  show  depraved  gen- 
eral health,  although  there  are  some  who  seem  to  be  in  "apparent  (  ?) 


512  PRACTICAL    HYDROTHERAPY. 

health."  Many  of  these  women  live  in  cities  and  follow  luxurious 
and  enervating  lives. 

There  is  another  type  of  women,  thin,  anemic,  the  subject  of  gastro- 
intestinal disturbances,  who,  barring  the  inflammatory  and  stenotic 
types,  is  distinctly  predisposed  to  neurotic  and  constitutional  disturb- 
ances, and  in  whom  menstruation  may  become  so  painful  as  to  under- 
mine the  general  health ;  they  do  not  recover  from  one  period  to 
another. 

It  may  be  stated  that  the  younger  the  sufferer  from  dysmenor- 
rhea the  more  defective  is  the  development  of  the  pelvic  organs.  Most 
females  suffering  from  dysmenorrhea  know  of  the  approach  of  the 
menstrual  epoch  through  certain  signs,  which  may  become  noticeable 
from  seven  to  ten  days  prior  to  the  onset  of  the  flow,  the  most  com- 
mon of  which  is  an  increased  nervous  irritability,  together  with  an 
aching  in  the  back  or  loins.  At  or  about  this  time  the  breasts 
become  tender,  and  a  sensation  of  fullness  is  experienced  in  the 
pelvis. 

Barring  the  truly  organic  and  secondary  inflammatory  cases,  I 
accept  Massey's1  explanation  of  the  condition  as  an  "almost  entirely 
neuro-muscular  phenomenon,  the  attempt  at  the  performance  of  an 
important  function,  while  either  the  nerve  centers  in  the  cord  or  the 
uterus  itself  are  in  an  unprepared  condition,  resulting  in  pain.  That 
the  spasm  alone  is  the  parent  of  the  pain,  rather  than  retained  secre- 
tion, is  more  than  likely,  as  associated  sequence  being  an  inhibition 
of  the  secretory  act  until  relaxation  has  occurred.  The  spasm,  in 
brief,  may  be  said  to  be  a  neuro-myotic  storm  of  the  uterine  neuro- 
muscular apparatus  which  renders  the  secretion  of  the  menstrual  fluid 
temporarily  impossible.  That  a  spastic  muscular  contraction,  most 
noticeable  at  the  internal  os,  usually  accompanies  dysmenorrhea  is 
undoubted,  and  there  is  reason  to  believe  that  the  contraction  may  be 
excited  by  the  sound  between  periods." 

Sexual  influences  often  play  a  most  important  part  in  the  cause 
of  this  condition  by  influencing  pelvic  congestion.  Strong  sexual  de- 
sires, under  forced  abstinence,  may  act  as  a  direct  cause.  Sudden 
cessation  of  sexual  activity  in  young  widows  is  productive  of  dysmen- 
orrhea and  many  neurotic  manifestations  of  a  hysteroid  character. 
Imperfect  or  unsatisfactory  intercourse  may  likewise  prove  a  source 
of  irritation  and  the  beginning  of  disorders  about  or  during  the  men- 
strual period.  This  is  a  most  delicate  point,  and  is  often  not  revealed 
until  sought  for,  because  of  a  feeling  of  modesty  and  a  general  disin- 
clination to  discuss  sexual  life  with  even  a  trusted  medical  adviser. 
Such  conditions,  if  suspected,  must  be  sought  for  and  corrected,  if 
possible.  The  deteriorating  influences  following  onanism  and  ex- 
cessive venery  influence  the  organs  directly  by  their  congestive  effects, 

1    Massey,  G.  Betton:  "Conservative  Gynecology  and  Electrotherapeutics,"  1905,  p.  98. 


DISEASES  OF  WOMEN.  513 

and  indirectly,  acting  through  the  sympathetic  and  central  nervous 
systems.     II ere  taet  and  diplomacy  are  at  a  distinct  premium. 

The  neurotic  and  constitutional  type  of  dysmenorrhea  fails  to 
reveal  itself  upon  the  most  careful  examination  for  local  disease  or 
disorders,  unless  possibly  we  may  consider  a  tender  ovary  significant. 
It  is  in  these  cases  that  the  pain  usually  precedes  the  flow  for  several 
days,  and  the  patient  becomes,  as  it  were,  primed  up  for  the  period; 
becomes  nervous,  sleepless,  has  headache,  dull,  heavy  backache,  de- 
pression of  spirits,  pains  in  the  hips  and  thighs,  tender  breasts,  and 
even  sensitive  throat.  The  pain  is  usually  greatest  during  the  first 
day.  is  periodic  in  duration  and  of  a  cramping  character.  Local  ex- 
amination at  this  time  presents  nothing  expulsive  in  type,  the  flow 
being  steady  and  regular.  Likewise  between  periods,  the  physical 
examination  of  the  patient  showns  no  inflammation  or  obstruction, 
no  endometritis,  no  leucorrhea,  no  intermenstrual  pain,  no  periuterine 
inflammation.  Neurotic  and  neurasthenic  conditions,  with  depre- 
ciated nerve  force,  sluggish  circulation  and  cold  extremities  are  usually 
present. 

In  girls  and  women  who  are  impressionable  and  overwrought  dur- 
ing the  period,  we  may  look  for  and  expect  hysterical  crises  and  an 
aggravation  of  all  the  bodily  states,  the  return  of  headaches,  neuralgia 
and  other  nervous  manifestations.  We  are,  therefore,  compelled  to 
conclude  that  the  attack  is  the  expression  of  a  neuro-muscular  storm, 
the  result  of  a  general  neurotic  or  hypersensitive  nervous  system. 
It  is  for  this  reason  in  these  cases,  and  in  virgins,  that  endeavor  should 
be  first  made  to  secure  relief  by  general  measures,  to  be  outlined, 
and.  such  external  or  cutaneous  applications  as  are  recommended. 
If  these  measures  fail,  a  local  examination  must  be  made  and  local 
treatment  instituted. 

In  the  inflammatory  type  of  dysmenorrhea  menstruation  is  like- 
wise accompanied  by  severe  pain ;  the  pulse  may  be  full  and  rapid, 
the  skin  hot  and  dry,  with  headache,  backache  and  pains  in  the  lower 
limbs.  They  are  much  affected  by  chronic  constipation,  and,  in  my 
experience,  have  been  singularly  disposed  to  hemorrhoids.  Women 
in  this  condition  are  very  sensitive  to  exposure  to  cold  and  moisture, 
and  yet  they  will  take  great  risks  of  getting  their  feet  wet,  or  will  sit 
on  cold  stone  steps,  wear  low-cut  shoes  and  thin  open-work  stockings, 
and  wonder  why  their  medical  adviser  cannot  prevent  or  immediately 
relieve  their  condition.  Where  the  dysmenorrhea  is  due  to  the  re- 
mains of  inflammatory  conditions  of  the  uterus  or  peritoneum,  which 
binds  down  this  organ  and  by  preventing  its  physiological  increase 
in  volume  during  the  menses  interferes  with  its  return  circulation, 
this  must  be  taken  into  consideration.  Prolapsed  ovary  is  not  an  un- 
usual accompaniment  of  this  condition. 

Bv   stenotic   or  obstructive   dvsmenorrhea   I   mean   those   cases   in 


514  PRACTICAL    HYDROTHERAPY. 

which  examination  reveals  an  actual  narrowing  of  the  canal,  the  con- 
dition known  as  "pin-hole  os."  where  a  small  probe  will  not  pass  without 
exquisite  tenderness  and  obstruction.  It  must  be  remembered  that 
what  is  obstructive  between  times  must  be  doubly  so  at  the  time  of 
the  period,  when  the  mucous  membrane  is  extensively  congested. 
Care  must  be  exercised  in  examining  these  cases  not  to  use  force ; 
handle  your  probe  as  you  would  a  pen.  not  a  leather  punch.  It  may 
be  stated  as  axiomatic  that  obstruction  causes  inflammation,  and  that 
the  essential  element  is  free  drainage. 

Hygienic  rules  of  health,  with  moderate  restrictive  exercise  in  the 
open  air.  and  a  diet  in  which  butter,  bread,  milk,  fruits  and  vegetables 
form  a  large  portion,  is  essential.  Constipation  is  to  be  carefully 
corrected,  and  the  use  of  morphine  and  other  narcotics  avoided.  The 
clothing  should  be  loose  and  in  nowise  interfere  with  the  circulation, 
and  for  this  reason  a  corset  that  constricts  the  waist  may  possibly 
prevent  cure  by  congesting  the  pelvic  organs  and  preventing  return 
circulation.  Good  shoes  with  thick  soles,  low  heels,  and  stockings  of 
sufficient  thickness  must  be  worn. 

Hydrotherapy  presents  one  of  the  most  efficient  therapeutic  weap- 
ons, both  palliative  and  curative,  at  the  command  of  the  physician, 
for  it  is  an  eliminant,  tonic  and  sedative,  and  its  use  is.  as  a  rule,  fol- 
lowed by  an  increase  in  flesh,  blood  and  relief  of  pain.  Between  the 
periods  we  should  always  employ  tonic  hydrotherapy,  and  this  can 
be  administered  in  any  home.  The  best  method,  however,  to  handle 
these  cases  is  that  of  institutional  treatment,  which  should  commence 
with  the  electric  light  bath  or  the  hot-air  bath  until  moderate  per- 
spiration is  produced,  followed  by  the  horizontal  rain  bath  at  100° 
to  102:  F.  for  one  or  two  minutes,  reduced  to  80°  F.  for  one-fourth 
minute,  pressure  twenty-five  pounds.  Decrease  the  temperature  two 
degrees  daily  to  65 c  F..  at  which  time  we  may  add  to  the  above 
treatment  the  jet  douche  at  a  temperature  of  60°  to  65°  for  five  to  ten 
seconds,  applied  to  the  lower  half  of  the  spine,  under  pressure  of 
twenty-five  pounds,  finishing  the  treatment  with  its  application  to  the 
hypogastrium  and  inner  surface  of  the  thighs.  This  is  an  especially 
valuable  treatment  if.  in  addition  to  the  dysmenorrhea,  we  have  a 
scanty  flow. 

Continental  authorities  are  very  fond  of  the  brief  cold  sitz  bath 
at  55°  to  65"  F.,  for  two  to  five  minutes.  Some  authorities  advise  the 
perineal  douche  at  55°  to  60'  F.  for  one  to  two  minutes,  strong  press- 
ure :  but  the  author's  experience  has  been  that  these  applications 
find  their  greatest  value  in  those  conditions  in  which  the  organs  are 
in  an  infantile  or  semi-infantile  state.  It  is  an  excellent  plan  of  treat- 
ment to  administer  in  the  morning  a  hot  saline  vaginal  douche,  three 
to  four  quarts,  temperature  110°  to  115°  F.,  and  during  the  day  give 
the  tonic   hydrotherapy  above  mentioned.     Endeavor   should  also  be 


DISEASES  OF  WOMEN.  515 

made  to  relieve  anemia,  chlorosis,  malaria,  neurasthenia,  hysteria, 
local  obstructive  conditions,  inflammation,  etc.  During  the  menstrual 
period  rest  in  bed  is  enjoined,  and  hot  applications  made  to  the  pelvic 
viscera.  Of  these  there  are  many,  the  simplest  of  which  is  the  fomen- 
tation at  120°  to  130°  F.  applied  to  the  hypogastrium  for  ten  minutes. 
The  hot  wet  pack,  hot  trunk  compress  to  the  pelvis  and  hips  at  115° 
to  120°  F.  for  twenty  to  thirty  minutes,  in  connection  with  the  use 
of  the  vaginal  douche  at  102°  to  105°  R,  or  rectal  enema  at  100°  to 
105°  F.,  will  oftentimes  bring  about  the  period  with  freedom  from 
pain.  Probably  the  most  satisfactory  method,  however,  is  the  hot 
sitz  bath  at  105°  to  110°  F.  for  five  to  ten  minutes;  or  the  hot  half 
or  the  hot  full  bath  at  104°  to  110°  F.  for  fifteen  minutes,  either  of 
which  is  to  be  followed  by  the  vaginal  douche  at  a  temperature  of 
102°  to  105°  F.  If  the  flow  is  scanty  the  two  last-mentioned  baths 
should  be  given  for  ten  to  fifteen  minutes;  if  profuse,  four  to  five 
minutes.  These  baths  may  be  administered  twice  daily,  morning  and 
night.  Hot  drinks  of  all  kinds  and  the  hot-water  bag,  will  be  found 
useful  between  times.  If-leucorrhea  is  present  antiseptics  and  astrin- 
gents should  be  added  to  the  douche.  It  is  astonishing  to  note  how 
many  cases  of  dysmenorrhea  will  be  relieved  by  these  general  and 
local  hydriatic  treatments. 

Endometritis;  Metritis. 

Fndometritis  is  an  inflammation  of  the  mucous  membrane,  and 
involving  to  a  greater  or  less  extent  the  parenchyma  of  the  uterus. 
The  mucous  membrane  of  the  uterus  is  not  analogous  to  other  mu- 
cous membranes  which  are  in  daily  or  hourly  activity,  the  function 
of  the  uterus  in  reproduction  being  called  into  exercise  only  occa- 
sionally; menstruation,  while  connected  with  reproduction,  is  not 
necessary  to  life. 

Predisposing  factors  are  of  great  importance,  and  are  found  in 
all  those  variations  from  what  we  call  "good  general  health."  It  may 
originate  from  anemia  and  chlorosis,  rheumatism,  gout,  tuberculosis  in 
all  forms,  the  exanthemata,  typhoid,  influenza;  from  the  present 
baneful  methods  of  schooling;  laborious  occupations;  obstinate  con- 
stipation ;  exposure  to  damp  cold,  especially  wet  skirts,  shoes  and 
stockings. 

Excessive  exercise,  over-exertion,  straining,  lifting,  blows  upon 
the  abdomen,  excessive  dancing,  long-continued  standing  upon  the 
feet  during  the  menstrual  period,  excessive  coitus  and  onanism  keep 
the  uterus  congested  and   favor  endometritis. 

Local  causes  aid  through  circulatory  disorders  and  bacterial  in- 
fection. Care  should  be  exercised  during  the  puerperal  state  to  avoid 
infection  from  unclean  hands  or  instruments,  irritating  tampons  and 
the  application  of  strong  medicines.     Where  true  stenosis  exists,  pre- 


516  PRACTICAL    HYDROTHERAPY. 

venting  drainage,  where  there  are  retained  secundines,  and  where 
there  is  acute  vaginitis,  we  may  expect  an  uterine  inflammation  to 
follow. 

Infection  by  micro-organisms  is  the  usual  rule,  the  most  common 
being  the  staphylococci  pyogenes  aureus  et  albus,  streptococci,  and  the 
micrococcus  of  Xeisser,  which  latter  occurs  usually  in  35  to  40  per 
cent,  of  all  cases.  A  patient  suffering  from  acute  endometritis  is  usu- 
ally in  bed,  complaining  of  pain,  weight  and  dragging  sensation  in 
the  pelvis,  together  with  considerable  rectal  and  vesical  tenesmus. 
The  pain  is  most  intense  just  above  the  pubes,  and  radiates  into  the 
groin  and  thighs.  There  is  a  dull,  heavy  soreness  over  the  sacro-spinal 
region  ;  the  bladder  is  usually  irritable  and  frequently  emptied.  The 
uterine  mucous  membrane  becomes  red,  swollen,  edematous,  softened, 
bleeding  easily,  a  discharge  of  mucus  or  muco-pus  being  usually 
present. 

The  existence  of  an  acute  purulent  inflammation  within  the  uterine 
cavity  renders  complications  an  easy  matter,  extension  of  the  inflam- 
mation occurring  by  continuity  of  tissue.  .Acute  endometritis  does 
not,  as  a  rule,  cause  death,  and  where  ordinary  care  and  attention  are 
given  by  the  patient  to  the  treatment  of  the  disease,  and  where  the 
medical  adviser  is  in  charge,  the  outcome,  so  far  as  the  acute  attack 
is  concerned,   is  generally   favorable. 

The  patient  is  put  to  bed  and  kept  at  perfect  rest,  a  daily 
or  twice  daily  hot  saline  enema  administered,  together  with  hourly 
drachm  doses  of  Epsom,  Rochelle  or  Crab  Orchard  salts  to  the 
point  of  free  catharsis.  The  enema  should  be  followed,  especially 
if  the  inflammation  is  due  to  a  suppression  of  the  menses,  by  the  use 
of  the  hot  trunk  pack,  the  trunk  compress  or  the  pelvic  pack  at  120° 
to  140°  F.  for  one  hour;  or  the  fomentation  at  130°  to  160°  F.  for 
ten  minutes,  repeated  for  ten  minutes;  or  the  hot  sitz  bath  or  the  hot 
full  bath  at  105°  to  110°  F.— 115°F.  if  possible— with  the  water  well 
over  the  hips,  for  ten  to  twenty  minutes.  Commence  with  a  lower 
temperature  and  rapidly  add  hot  water  until  the  highest  possible  tem- 
perature is  reached.  The  patient  is  then  removed  to  bed,  first  a  hot 
antiseptic  saline  vaginal  douche  given,  then  wrapped  in  a  hot  dry 
pack,  with  a  hot-water  bag  to  the  pelvic  region  and  another  to  the 
feet.  Hot  drinks  to  promote  diaphoresis  may  be  administered.  Any 
of  the  above  treatments  may  be  given  twice  daily,  in  the  morning  and 
evening.  The  diet  should  be  exceedingly  simple,  usually  liquid,  free 
from  meat  and  meat  soups,  and  to  consist  preferably  of  milk,  Vichy 
water  and  prepared  infants'  foods.  During  the  attack  or  convales- 
cence, in  addition  to  the  foregoing  measures,  we  may  employ  the  cold 
sponge  at  75°  to  50°  F.  once  or  twice  daily,  in  order  to  energize  the 
nerves  and  vital  forces.  As  soon  as  the  patient  is  able  to  stand  upon 
her  feet,  the  dripping  sheet  at  the  same  temperature,  with   vigorous 


DISEASES  OF  WOMEN.  51/ 

friction,  avoiding,  however,  the  lower  abdominal  and  pelvic  regions, 
may  he  employed.  Its  duration  should  range  from  two  to  five  minutes 
daily  ;  reduce  two  degrees  with  each  application  until  the  lower  tem- 
perature is  reached.  As  the  patient  begins  to  walk  around,  the  warm 
full  bath  at  100°  F.  for  five  minutes,  followed  by  the  salt  rub  and 
cold  shower  at  65°  to  50°  F.  for  ten  to  fifteen  seconds,  will  be  found 
an  excellent  measure. 

Such  vigorous  treatment  usually  results  in  a  very  prompt  subsi- 
dence of  the  acute  attack,  which  may  or  may  not  be  followed  by  a  sub- 
acute or  chronic  condition.  The  administration  of  a  high-tension 
vaginal  bipolar  faradic  treatment  will  subdue  pain.  As  soon  as  there 
is  a  complete  subsidence  of  the  acute  inflammation  we  may  follow  the 
plan  outlined  for  chronic  endometritis. 

Chronic  Endometritis;  Metritis. 

I  still  adhere  to  the  time-honored  belief  that  we  have  here  to  deal 
with  a  chronic  inflammation  of  the  endometrium,  which  may  or  may 
not  involve  the  parenchyma  of  the  uterus.  Pozzi  has  simply  and 
clearly  called  attention  to  the  symptoms  of  this  disease,  which  is  man- 
ifested by  a  syndrome  consisting  of  pain,  local,  transferred  or  reflex  ; 
leucorrhea,  dysmenorrhea,  uterine  hemorrhage,  with  symptoms  in 
neighboring  and  distant  organs. 

Chronic  endometritis  may  follow  an  acute  attack,  may  develop 
from  malposition  of  the  uterus,  from  laceration,  syphilis,  gonorrhea, 
or  from  microbic  infections.  There  is  usually  dull  pain  in  the  thighs 
and  back,  together  with  uterine  hemorrhage  or  blood-streaked  dis- 
charges. The  bladder  is  usually  involved,  frequent  desire  to  evacuate 
being  present. 

Certain  general  facts  should  always  be  borne  in  mind  in 
the  treatment  of  chronic  endometritis,  it  being  axiomatic  that  the 
better  the  general  health  of  the  patient  the  quicker  will  the  endome- 
tritis improve.  For  this  reason  we  should  search  diligently  for  those 
variations  in  nutrition  and  elimination  that  are  oftentimes  associated 
with  the  local  inflammation.  Especial  search  should  be  made  for 
anemia,  chlorosis,  neurasthenia,  digestive  disorders  and  constipation. 
Where  possible,  eliminate  worry  and  care.  The  local  treatment  must 
always  be  considered  in  the  light  of  existing  complications. 

The  diet  should  be  mixed,  nourishing,  and  from  which  all  rich. 
highly  seasoned,  spiced  and  indigestible  foods  have  been  removed. 
Any  digestive  disturbance  must  be  given  attention.  Gentle  and  mod- 
erate exercise,  together  with  certain  gymnastics,  deep  breathing,  erect 
and  in  the  genu-pectoral  position,  will  materially  aid  in  exercising 
the  muscular  pelvic  floor,  as  well  as  the  abdominal  and  perineal  mus- 
cles. In  some  cases  massage,  local  and  general,  is  of  value.  The 
dress  should  be  free  from  waist  constrictions,  especially  where  there  is 


518  PRACTICAL    HYDROTHERAPY. 

a  tendency  toward  impediment  of  the  return  circulation  from  the 
pelvis.  The  clothing  must  be  light,  with  the  major  portion  of  the 
weight  carried  by  the  shoulders.  In  women  who  are  naturally  slim 
and  who  have  never  had  recourse  to  tight  lacing,  a  snug-fitting  waist 
may  be  allowed. 

The  home  treatment  of  such  cases  should  commence  with  the  cold 
sponge  at  70°  F.,  rapidly  performed,  the  temperature  being  reduced 
two  degrees  daily  to  50°.  At  this  point  the  warm  full  bath  at  100° 
to  102°  F.  for  five  minutes  may  be  followed  by  the  sponge  as  above. 
When  the  patient  begins  to  react,  continue  the  warm  full  bath  at  102° 
F.  for  five  minutes,  and  while  the  patient  stands  in  the  tub  give  a 
rapid  salt  rub,  followed  by  the  cold  shower  at  65°  to  55°  F.  for  ten 
to  fifteen  seconds.  This  will  be  found  a  very  valuable  measure  for 
home  treatment.  Where  the  shower  cannot  be  obtained  the  warm 
full  bath  and  salt  rub  may  be  employed,  followed  by  an  affusion  to 
the  chest  and  back  at  65°  to  60°  F.  The  general  sanatorial  manage- 
ment of  the  case  commences  with  the  administration  of  any  of  the 
above  methods,  or  the  electric  light  bath  to  the  point  of  perspiration, 
followed  by  the  rain  bath  at  100°  to  102°  F.  for  one  to  two  minutes, 
reduced  to  80°  F.  for  one- fourth  minute,  pressure  twenty  pounds ; 
reduce  the  temperature  two  degrees  daily  to  60°  F.,  and  increase  the 
pressure  one  pound  daily  until  thirty  is  registered. 

Where  we  have  to  deal  with  women  who  are  the  possessors  of  a 
fair  degree  of  flesh  and  fat,  we  may  change  the  above  at  the  end  of 
a  week  to  the  following  treatment,  provided  their  reaction  has  become 
well  established :  Electric  light  bath  to  the  point  of  free  perspiration, 
followed  by  the  horizontal  rain  bath  at  a  temperature  of  102°  to  104° 
F.  for  one  and  one-half  minutes,  followed  in  its  turn  by  the  jet  douche 
to  the  spine  and  posterior  aspect  of  the  lower  limbs  at  65°  F.  for  ten 
to  twenty  seconds,  pressure  twenty  to  thirty  pounds. 

The  local  management  demands  the  daily  or  twice  daily  use  of 
the  vaginal  douche,  using  a  hot  normal  saline  solution  at  115°  to  130° 
F.,  three  to  four  quarts. 

When  leucorrhea  is  present,  especially  where  it  is  due  to  micro- 
organisms, we  may  employ  the  douche  of  normal  saline  solution  or 
one  containing  antiseptics  and  astringents,  among  which  may  be  men- 
tioned hot  permanganate  of  potassium  (1:500  to  1:1000)  or  hy- 
drargyrum bichloride  (1:3000  to  1:5000).  Where  much  pain  is 
present  we  can  use  the  prolonged  neutral  sitz  bath  at  95°  to  97°  F. 
for  fifteen  to  thirty  minutes  once  or  twice  daily,  or  the  very  hot  sitz 
or  half  bath  as  hot  as  can  be  borne;  where  these  baths  cannot  be 
administered  employ  the  pelvic  pack  or  trunk  pack  at  130°  to  140°  F. 
for  thirty  minutes.  At  the  menstrual  period,  if  much  pain  and  dimin- 
ished flow  are  present,  the  hot  sitz  bath  at  105°  to  110°  F.  for  ten  to 
fifteen  minutes,   followed   by  a  vaginal   douche   at    100°   to   102°    F., 


DISEASES  OF  WOMEN.  519 

usually  brings  about  relief  of  pain  and  starts  bleeding.  Where  these 
measures  are  not  at  hand  we  may  use  the  very  hot  compress,  the 
fomentation,  or  pelvic  pack,  at  130°  to  150°  F.,  applied  to  the  pelvic 
region  for  ten  minutes,  repeated  for  ten  minutes,  the  treatment  to  be 
given  twice  daily. 

The  hot  springs  of  Arkansas  and  Virginia,  the  Pagosa  of  Colorado, 
the  Las  Vegas  and  Oja  Caliente  of  New  Mexico,  have  gained  some 
little  reputation  from  their  use  of  the  hot  full  and  hot  sitz  bath  in 
conjunction  with  the  internal  use  of  the  waters. 

Uterine  Displacements. 

The  influence  that  hydrotherapy  exerts  is  a  secondary  one  to  the 
mechanical  and  surgical  management.  Its  action  is  limited  to  the 
general  tonic  up-building  that  results  from  its  general  use,  though  it 
must  be  said  that  in  many  cases  this,  in  connection  with  the  use  of 
local  electrical  and  mechanical  treatment,  frequently  results  in  such 
an  improvement  of  the  statics  of  the  uterus  that  functional  cure  is 
brought  about,  for  it  is  an  interesting  fact  that  after  such  a  course 
of  treatment  women  remain  in  excellent  health,  in  spite  of  the  fact 
that  their  uteri  are  not  a  la  mode,  or  according  to  text-book  cuts. 
To  this  end  we  may  use  the  electric  light  bath  to  the  point  of  free 
perspiration,  followed  by  the  horizontal  rain  bath  at  102°  F.  for  one 
minute,  reduced  to  80°  F.  for  one-fourth  minute,  pressure  twenty  to 
thirty  pounds.  Reduce  the  temperature  two  degrees  daily  to  65°  or 
60°  F.  This  should  be  immediately  followed  by  the  cold  sitz  bath 
at  65°  to  60°  F.  for  two  to  five  minutes,  accompanied  by  friction 
applied  to  the  abdominal  wall  and  internal  and  external  surfaces  of 
the  thighs  by  the  patient,  while  the  nurse  also  applies  friction  over  the 
lower  spinal  region  and  the  buttocks. 

Hydrotherapy's  principal  value  lies  in  its  powerful  influence  in 
building  up  the  general  health,  improving  circulation,  bettering  diges- 
tion and  assimilation,  relieving  inflammation,  congestion  and  stasis, 
increasing  elimination,  and  in  this  way  placing  the  patient  in  a  state  of 
general  good  health.  By  relieving  accompanying  conditions  local 
electrical  and  mechanical  treatment  may  bring  about  functional  cure. 
If  it  is  impossible  to  carry  out  the  treatment  as  above  outlined  in  some 
hydriatic  institution  we  may  have  recourse  to  the  following  "home" 
methods :  Commence  with  the  dripping  sheet  at  80°  F.  for  three  min- 
utes, with  vigorous  friction,  the  temperature  of  which  is  reduced  two 
degrees  daily  to  60°  and  even  50°  F. ;  or  the  full  wet  pack,  starting 
at  a  temperature  of  80°  F.  for  thirty  minutes,  reduced  five  degrees 
to  60°  F.  and  increased  five  minutes  daily  until  a  duration  of  one 
hour  is  attained.  Both  of  these  should  be  followed  by  the  use  of  the 
cold  sitz  bath  at  65°  to  60°  F.  for  two  to  five  minutes,  with  friction 
as  above  described.     This  treatment  can  be  given  in  any  home,  and 


520  PRACTICAL    HYDROTHERAPY. 

will  oftentimes  be  sufficient  for  restoration  and  cure,  in  conjunction 
with  the  use  of  electricity,  massage  and  glycerine  tampons. 

Uterine     Hemorrhage;    Menorrhagia  and  Metrorrhagia. 

Menorrhagia  is  an  excessive  flow  of  blood  at  the  menstrual  period ; 
metrorrhagia  is  a  hemorrhage  from  the  uterus  independent  of  the 
period ;  both  constitute  forms  of  the  generic  term,  uterine  hemorrhage. 
The  older  terms  are  retained,  but  the  difference  between  the  two  and 
the  line  separating  them  is  a  fanciful  one  of  theory  rather  than  reality. 
The  blood  sometimes  lost  during  a  year  is  remarkable.  The  trouble 
may  arise  from  general  conditions — hemophilia,  scurvy,  anemia, 
chlorosis,  malaria,  syphilis,  tuberculosis  (incipient),  septic  infections, 
general  debility,  cardiac  disease,  diseases  of  the  liver,  spleen,  kidneys, 
nervous  and  mental  conditions,  hysteria,  fright,  change  of  climate,  etc. 
Local  causes  are  uterine,  tubal  or  ovarian  in  character,  such  as  dis- 
placements, malignant  disease,  tumors,  lacerations,  chronic  inflamma- 
tions, and  any  cause  obstructing  the  return  of  blood  from  the  pelvis. 
These  conditions  must  be  met  in  the  management  of  the  case,  and  the 
reader  is  referred  to  the  particular  section  for  information. 

General  measures  to  be  suggested  in  connection  with  these  cases 
are  rest  in  bed,  nutritious  diet,  laxatives,  attention  to  digestion  and 
abdominal  support.  General  conditions  are  best  met  by  general 
measures,  but  the  following  may  be  used,  combining  as  it  does  general 
and  local  therapy :  Electric  light  bath  to  free  perspiration,  followed  by 
the  horizontal  rain  bath  at  102°  F.  for  one  minute,  pressure  twenty-five 
pounds,  reduced  to  80°  F.  for  one-fourth  minute.  Reduce  two  de- 
grees daily  to  65°  F.,  and  follow  by  a  moderately  prolonged  sitz  bath 
at  65°  to  50°  F.  for  five  to  fifteen  minutes,  accompanied  by  friction 
to  the  abdominal  wall  and  inner  and  external  surfaces  of  the  thighs, 
while  at  the  same  time  a  hot  foot-bath  at  110°  to  115°  F.  is  adminis- 
tered. In  case  the  electric  light  and  rain  baths  cannot  be  given  the 
sitz  bath  may  be  preceded  by  the  use  of  the  dripping  sheet,  com- 
mencing at  a  temperature  of  80°  F.,  duration  three  minutes,  accom- 
panied by  vigorous  friction.  Make  the  sheet  a  little  wetter  from  day 
to  day  and  decrease  the  temperature  two  degrees  until  60°  to  50°  F. 
is  reached.  The  sitz  is  used  immediately  after  this.  The  author  has 
seen  excellent  results  in  uterine  hemorrhage  arise  from  the  use  of 
Chapman's  double-column  spinal  hot-water  bag  applied  over  the 
lumbo-sacral  region  at  a  temperature  of  115°  to  120°  F.  for  twenty 
to  sixty  minutes,  repeated  as  needed.  Attention  should  be  paid  to  the 
fact  that  the  action  of  the  prolonged  cold  sitz  bath,  accompanied  by 
friction,  is  to  cause  profound  and  extensive  contraction  of  the  internal 
pelvic  and  abdominal  blood-vessels. 

In  the  local  management  of  these  cases  the  very  hot  vaginal  douche 
at  110°  to  120°  F.,  one  to  two  gallons  normal  saline  solution,  followed 


DISEASES  OF  WOMEN.  521 

by  the  cold  trunk  compress,  cold  pelvic  pack,  or  the  half  wet  pack 
applied  to  the  hypogastrium  and  inner  thighs,  accompanied  by  the  hot 
foot-bath  at  110°  to  120°  R,  with  a  duration  of  twenty  to  thirty 
minutes,  oftentimes  checks  the  hemorrhage  when  many  other  things 
fail.  Winternitz  has  suggested  in  extreme  cases  the  use  of  cold  water 
in  a  vaginal  douche,  but  of  this  the  author  has  no  experience,  as  he 
has  been  able  to  control  the  hemorrhage  by  the  measures  above  sug- 
gested. These  are  cases  that  distinctly  require  more  or  less  prolonged 
cold  applications,  in  which  prolonged  hot  or  warm  douches,  sitz  and 
foot-baths,  fomentations  and  compresses  are  contraindicated,  as  are 
also  short  very  cold  applications  to  the  lower  spine,  abdomen,  thighs 
or  feet,  as  they  increase  internal  pelvic  circulation. 

Abortion. 

Abortion  is  the  expulsion  of  the  product  of  conception  of  preg- 
nancy, alive  or  dead,  before  the  period  of  viability,  now  considered 
the  sixth  month.  It  may  be  brought  about  by  conditions  of  the 
maternal  general  health  and  local  conditions  in  the  uterus,  from  pa- 
ternal causes  (advanced  age,  lowered  vitality,  syphilis,  alcoholism  and 
tuberculosis),  from  degenerations  in  the  fetal  membranes,  or  with 
criminal  intent.  Its  dangers  are  hemorrhage  and  infection.  Some 
women  habitually  abort  as  the  result  of  syphilis,  lead,  tobacco  poison- 
ing and  heart  disease.  Local  causes  exist  in  malformations,  displace- 
ments, etc. 

The  first  thing  to  be  done  is  to  curette  the  uterus,  by  means 
of  which  septic  matter  is  removed,  and  after  this  asepsis  must 
be  maintained.  Positive  rest  is  essential,  and  three  or  four  times 
daily  the  vaginal  douche  of  hot  saline  or  antiseptic  solution  should  be 
administered.  Where  the  condition  is  habitual  causative  factors  must 
be  sought  for  and  treated,  and  as  far  as  possible  the  general  health 
built  up  by  tonic  hydrotherapy.  Weber  says  that  those  women  who 
habitually  abort  because  of  cardiac  disease  may  frequently  be  brought 
to  full  term  by  the  use  of  the  Nauheim  or  C02  baths,  and,  further, 
that  these  baths  have  a  tendency  to  prevent  the  condition  where  other 
causes  are  at  fault.  Following  miscarriage  the  woman's  health  is  apt 
to  deteriorate,  and  the  sooner  she  can  be  placed  in  good  general  health 
the  better  for  her.  Commence  with  the  cold  sponge  at  85°  F.  once  or 
twice  daily,  followed  by  friction  with  a  crash  towel,  avoiding  the  lower 
abdominal  wall;  reduce  the  temperature  two  degrees  daily  until  60°  F. 
is  reached,  at  which  time  we  may  institute  the  dripping  sheet  at  60°  F. 
for  three  minutes,  preferably  given  before  breakfast.  Where  institu- 
tional treatment  can  be  obtained  she  should  be  placed  upon  the  electric 
light  bath  to  free  perspiration,  followed  by  the  horizontal  rain  bath  at 
100°  to  104°  F.  for  one  to  two  minutes,  reduced  to  60°  F.  for  one- 
fourth  minute,  pressure  twenty-five  to  thirty  pounds.       Where  sub- 


522  PRACTICAL    HYDROTHERAPY. 

involution  exists  this  treatment  may  be  followed  by  the  use  of  the 
cold  sitz  bath  at  50°  to  60°  F.  for  two  to  five  minutes,  accompanied 
by  vigorous  friction  on  the  part  of  the  patient  to  the  lower  abdominal 
wall  and  the  inner  side  of  the  thighs,  and  by  the  nurse  to  the  lower 
back  and  buttocks. 

Eclampsia. 

Puerperal  convulsions  is  a  symptomatic  disorder  characterized  by 
convulsive  seizures  coming  on  suddenly  prior  to,  during  or  after  labor. 
Prevention  is  easy  for  him  who  watches  the  urine  for  the  amount  of 
urea  excreted,  albumin,  casts,  etc.  If  necessary  abortion  must  be 
induced. 

Post-partum  eclampsia,  with  its  wide-open  eyes,  fixed  stare,  con- 
tracted pupils,  rapidly  closing  and  opening  lids,  clonic  convulsions, 
irregular  heart  action,  stertorous  breathing,  is  characteristic  when 
taken  in  conjunction  with  the  clinical  history.  Seizures  vary  in  num- 
ber. Nature  frequently  produces  spontaneous  abortion.  Its  path- 
ology is  that  of  toxemia,  probably  due  to  the  products  of  tissue  metab- 
olism, a  condition  that  is  present  in  a  mild  form  in  every  case  of  preg- 
nancy. This  poison  seems  to  not  be  uniform,  more  virulent  in  primip- 
arse  and  remaining  inactive  so  long  as  the  kidney  is  sufficiently  intact. 
Of  late  years  the  mortality  has  decreased. 

Should  the  convulsions  be  imminent  or  have  commenced,  treat- 
ment is  the  same.  No  solid  food  is  given  the  patient  at  all,  the 
only  nourishment  being  iced  milk,  with  the  ingestion  of  water  at 
short  intervals  where  this  is  possible.  Free  catharsis  is  demanded 
and  one  drachm  of  Epsom  or  Crab  Orchard  salts  in  six  or  eight 
ounces  of  water  may  be  taken  every  hour  until  complete  liquefaction 
of  the  bowel  movements  takes  place.  Give  hot  enemata  of  normal 
saline  every  three  or  four  hours,  regardless  of  intestinal  activity. 
Hypodermoclysis  of  one  to  two  or  more  pints  of  normal  saline  or 
Jardine's  solution  ( potassium  bicarbonate  and  sodium  carbonate, 
drachm  one  to  a  pint)  should  be  introduced  at  the  edge  of  the  breasts 
or  into  the  abdomen  after  delivery.  It  at  once  promotes  diuresis  and 
diaphoresis,  and  this  may  be  kept  up  and  elimination  favored  by  the 
following:  Hot  full  bath  at  104°  to  106°  F.  for  ten  to  thirty  minutes, 
repeated  every  two  to  three  hours.  The  duration  of  this  bath  may  be 
increased  each  time  it  is  given  five  to  ten  minutes  until  a  duration  of 
thirty  minutes  is  secured.  It  should  be  followed  by  the  hot  full  dry 
pack  for  one  hour.  Some  authorities  have  found  that  continuous 
irrigation  of  the  rectum  with  a  normal  saline  solution  at  115°  F.  is 
a  very  effective  measure.  The  treatment  above  suggested  does  not  in 
any  sense  interfere  with  the  usual  medicinal  measures. 


DISEASES  OF  WOMEN.  523 

Salpingitis. 

Salpingitis  is  an  inflammation  of  the  Fallopian  tubes,  is  of  frequent 

occurrence,  and,  because  of  its  tenacity,  the  serious  organic  and  func- 
tional changes  that  follow,  is  productive  of  much  invalidism  in  the 
female.  It  originates  most  frequently  from  the  uterus  by  continuity 
of  tissue,  the  inflammation  traveling  unobstructed  into  the  tube.  It 
is  almost  without  exception  infectious  and  of  microbic  origin,  the 
most  common  germs  being  the  streptococcus  and  gonococcus.  The 
former  gains  entrance  from  unclean  bands,  instruments,  from  puer- 
peral state,  etc.,  through  the  lymphatics  into  the  deeper  structures, 
rising  to  the  epithelial  surfaces,  causing  a  rapid  and  prompt  invasion, 
ushered  in  by  chill,  high  temperature,  increase  in  pulse-rate  and 
adynamia.  The  gonococcus,  a  frequent  cause,  gains  entrance  from 
the  uterus  and  travels  along  the  surface  of  the  epithelial  coverings  of 
the  tube  bringing  about  desquamation  of  the  surface  cells.  It  is  found 
in  about  20  per  cent,  of  the  cases  in  which  it  is  the  cause,  but  this 
does  not  invalidate  the  remaining  80  per  cent,  of  cases,  as  it  is  a  short- 
lived germ,  that  perishes  easily,  although  in  certain  localities,  such  as 
the  vulvo-vaginal  glands,  it  exists  indefinitely.  It  thrives  in  the 
urethra,  cervical  canal  and  uterus ;  is  short-lived  in  the  tubes.  Other 
germs  produce  salpingitis.  Salpingitis  may  be  catarrhal  or  inter- 
stitial, the  former  superficial  in  character,  the  latter  involving  the 
parenchyma.  Recovery  taking  place,  we  may  have  a  low-grade  in- 
flammation, with  overgrowth  of  connective  tissue  lasting  for  years, 
converting  the  tube  into  a  dense  fibrous  structure.  Localized  peri- 
tonitis from  the  passage  to  the  peritoneum  may  result  in  an  exudate 
and  walling  off  of  the  tube.  The  tube  may  become  distended,  forming 
pyosalpinx  (pus),  hydrosalpinx  (water),  or  hematosalpinx  (blood). 
The  tube  may  become  enlarged,  infiltrated  and  distorted.  The  septic 
material  may  escape  and  result  in  a  matting  together  of  all  neighboring 
organs  by  adhesions.  Salpingitis  is  frequently  the  cause  of  sterility, 
by  occluding  the  tube  or  rendering  the  passage  of  the  ovule  so  slow 
as  to  enfeeble  it  and  prevent  fecundation.  Usually  pain,  tenderness, 
uterine  hemorrhage  and  physical  symptoms  are  present.  A  tube  once 
the  subject  of  salpingitis  can,  through  a  very  slight  indiscretion,  again 
become  the  seat  of  a  fresh  attack. 

In  the  acute  stage  the  important  point  should  be  to  control 
the  inflammation,  limit  exudation  and  prevent  the  spread  of  in- 
fectious material.  This  can  only  be  obtained  by  absolute  rest  in 
bed,  with  a  nurse  in  attendance,  and  the  use  of  the  bed-pan  for  the 
bowel  and  kidney.  Free  catharsis  must  at  once  be  secured,  and  to 
this  end  give  Epsom,  Rochelle  and  Crab  Orchard  salts,  drachms  one 
in  eight  to  twelve  ounces  of  water,  every  hour.  As  a  result  of  free 
catharsis  the  bowel  will  be  unloaded,  fluid  withdrawn  from  the  pelvis, 


524  PRACTICAL    HYDROTHERAPY. 

its  tissues  depleted,  absorption  stimulated,  pain  and  suffering  relieved. 
Eneinata  of  normal  saline  are  to  be  used  twice  daily,  regardless  of 
bowel  movements.  The  diet  must  be  liquid  and  the  patient  urged  to 
drink  large  quantities  of  water.  The  vaginal  douche  at  110°  to  115° 
F.  of  normal  saline  solution,  twice  daily,  will  remove  the  acrid,  foul- 
smelling,  abundant  discharges.  If  the  infection  is  gonorrheal,  anti- 
septics are  added  to  the  douche.  It  should  be  followed  immediately 
by  the  fomentation  at  130°  to  160°  F.  for  ten  minutes,  repeated  for 
ten  minutes,  during  which  time  the  feet  are  immersed  in  a  foot-bath 
as  hot  as  can  be  borne.  This  treatment  is  repeated  every  two  to  four 
hours,  and  in  the  interval  the  ice-bag  is  applied  over  the  inflamed 
tube. 

In  subacute  attacks,  the  prolonged  vaginal  douche  at  110°  to  115° 
F.,  two  to  three  gallons,  lasting  at  least  fifteen  minutes,  will  be  found 
an  excellent  measure.  The  prolongation  of  the  hot  water  decreases 
the  quantity  of  blood,  astringes  the  tissues,  lessens  the  caliber  of  the 
blood-vessels  and  checks  inflammation ;  it  may  be  used  one  to  three 
times  daily.  Fresh  air,  moderate  exercise,  nutritious  diet,  regular 
habits  and  sexual  rest  are  essential.  Should  pyosalpinx  develop  the 
case  becomes  surgical,  and  if  necessary  an  operation  must  be  per- 
formed. By  means  of  hydrotherapy  we  may  limit  the  ravages  of  the 
disease  in  scope,  intensity  and  structural  changes.  Some  cases  will  be 
unchecked ;  these  are  comparatively  few.  Many  will  recover  entirely 
and  others  be  so  improved  as  to  escape  the  necessity  of  an  operation. 

Chronic  cases  are  benefited  by  rest,  retiring  early,  sleeping  late 
and  spending  part  of  the  day  in  a  recumbent  position.  In  the  home 
management  we  may  institute  upon  arising  in  the  morning  the  dripping 
sheet  at  60°  F.  for  three  minutes,  accompanied  by  vigorous  friction, 
avoiding  the  lower  abdominal  region;  or  the  full  hot  bath  at  100°  to 
104°  F.  for  five  minutes,  followed  by  the  cold  shower  at  80°  F.  for 
one- fourth  minute ;  reduce  two  degrees  daily  to  60°  F.  Where  this 
cannot  be  carried  out  we  may  try  the  method  of  Kellogg2,  which  the 
author  can  recommend :  Hot  pack  to  the  pelvis  and  thighs  for  thirty 
minutes,  followed  by  the  stimulating  trunk  compress  or  wet  half  pack 
at  65°  F.  for  three  hours,  or  until  the  next  hot  pack  is  applied;  in 
addition,  the  hot  saline  enema  and  vaginal  douche,  once  daily,  as  well 
as  an  occasional  dose  of  saline.  In  the  institutional  management  the 
author  prefers  the  electric  light  bath  or  the  superheated  dry  hot  air 
body  apparatus,  preferably  the  latter,  to  free  perspiration,  twenty  to 
forty  minutes,  followed  by  the  horizontal  rain  bath  at  75°  F.  for  one- 
half  minute.  Sunshine,  moderate  exercise,  nutritious  diet  and  tonics 
are  indicated. 

2  Kellogg,  J.   II.:   "Rational   Hydrotherapy,"   1906. 


DISEASES  OF  WOMEN.  525 

Acute  Oophoritis. 

Acute  oophoritis  is  an  acute  Inflammation  of  the  ovary.  The  most 
frequent  origin  of  the  disease  is  streptococcus  infection  from  a 
purulent  salpingitis,  although  infection  may  reach  the  ovaries  by  the 
lymphatics  from  the  uterus  itself.  Trauma,  mechanical  irritation, 
prolonged  congestion,  sudden  suppression  of  the  menses  and  the  erup- 
tive fevers  are  occasionally  accompanied  by  ovarian  inflammation. 
Puerperal  sepsis  is  a  frequent  cause.  The  gonococcus,  the  colon 
bacillus  (when  the  ovary  is  adherent  to  the  rectum)  and  the  pneumo- 
coccus  may  cause  the  trouble.  The  ovary  becomes  swollen,  edem- 
atous and  infiltrated,  its  surface  covered  with  lymph,  which  later  forms 
adhesions  with  the  adjacent  organs.  Milder  forms  subside  without  pus 
formation ;  others  show  small  foci  of  pus  scattered  through  the  stroma ; 
in  others  an  abscess  results.  Many  become  the  seat  of  chronic  inflam- 
mation. Ovarian  abscesses  may  rupture ;  usually  the  condition  results 
in  the  pus  becoming  sterile  or  converted  into  a  cheesy  mass.  Some 
inflammations  run  their  course  with  little  apparent  danger  to  the  ovary. 
The  onset  is  generally  by  chill,  fever,  nausea,  vomiting,  tenderness 
and  pain,  greatest  over  the  site  of  the  ovary.  Physical  examination 
usually  shows  the  ovary  to  be  enlarged,  tender  and  prolapsed  behind 
the  uterus. 

The  aim  should  be  to  restrict  the  inflammation  and  limit 
its  after-effects,  and  to  this  end  absolute  rest  in  bed  and  the  use 
of  the  bed-pan  for  the  calls  of  Nature  are  essential.  Epsom  or  Crab 
Orchard  salts  in  drachm  doses,  dissolved  in  eight  to  twelve  ounces  of 
water,  every  hour  until  free  purgation  takes  place ;  the  use  of  a  hot 
enema  of  normal  saline  solution  three  times  daily ;  and  a  vaginal  douche 
at  110°  to  120°  F.,  using  two  gallons  of  normal  saline,  repeating  every 
six  to  eight  hours.  Every  three  hours  fomentations  should  be  applied 
to  the  pelvis  at  a  temperature  of  130°  to  160°  F.  for  ten  minutes, 
repeated  for  ten  minutes  and  followed  by  the  ice-bag  over  the  ovary 
involved.  Where  both  are  involved,  the  ice-bag  should  be  of  sufficient 
size  to  cover  the  entire  area.  It  is  important  to  keep  the  hot-water  bag 
constantly  to  the  feet.  The  diet  is  liquid,  and  nothing  is  better  than 
iced  milk  or  iced  carbonated  milk.  Free  water-drinking  is  to  be 
enjoined,  meats,  soups  and  alcohol  avoided.  As  soon  as  possible  the 
cold  sponge  may.be  commenced  for  its  tonic  and  reconstructive  prop- 
erties. Start  with  a  temperature  of  90°  F.  and  rapidly  reduce  the  tem- 
perature two  to  three  degrees  each  sponging  until  60°  F.  is  reached,  at 
which  it  may  be  maintained.  If  the  fever  rises  above  103°  F.  the 
temperature  of  the  sponge  may  be  made  constantly  colder — 50°  to 
40°  F.  If  pus  forms  abdominal  section  should  be  performed  with 
every  safeguard,  owing  to  the  well-known  deadly  rancor  of  ovarian  pus. 


526  PRACTICAL    HYDROTHERAPY. 

Chronic  Oophoritis. 

Chronic  oophoritis  is  a  chronic  inflammation  of  the  ovary,  having 
its  origin  from  a  variety  of  causes.  It  is  more  common  than  the  acute, 
and  occurs  most  frequently  during  the  child-hearing  period  of  life. 
It  may  be  a  sequela  of  an  acute  inflammation,  from  a  gonorrheal  endo- 
metritis, from  syphilis,  from  congestive  conditions  due  to  defective 
circulation,  such  as  displacements;  from  masturbation,  excessive  sexual 
intercourse,  unsatisfied  sexual  desires,  excessive  alcohol,  tumors,  ster- 
ility and  celibacy.  Congestion  of  the  ovary  is  common  in  young  girls 
at  puberty,  who  devote  little  time  to  their  physique  and  much  time  to 
studies.  The  ovary  is  enlarged,  frequently  studded  with  small  cysts,  or 
becomes  the  subject  of  interstitial  inflammation,  cirrhotic,  atrophic 
and  buried  in  dense  adhesions.  It  is  frequently  associated  with  endo- 
metritis, salpingitis,  pelvic  tumors,  etc.  More  or  less  continual  pain 
and  tenderness  are  present,  especially  on  pressure,  during  exercise, 
standing,  defecation  and  coition.  Menorrhagia  may  be  present,  as  are 
many  digestive,  nervous  and  some  mental  symptoms. 

Rest  is  a  feature  in  the  chronic  state,  and  to  this  end  the 
patient  should  secure  plenty  of  sleep  at  night  and  a  nap  during  the 
day.  Absolute  rest  on  the  flat  of  the  back  during  the  menstrual  period 
must  be  enjoined.  Separate  beds  should  be  occupied  at  night  and 
coitus  forbidden.  Light  clothing,  suspended  from  the  shoulders,  with- 
out constriction  at  the  waist,  and  a  snug,  tight  and  closely  fitting  ab- 
dominal bandage  worn.  Good,  plain,  simple  but  nutritious  diet,  drink- 
ing of  pure  water,  moderate  exercise  in  the  open  air  and  sunshine  and 
frequent  deep  breathing  exercises.  The  abdominal  exercises  standing 
and  in  the  knee-chest  position  will  sometimes  be  found  valuable.  Lax- 
atives may  be  given  nightly  and  a  saline  once  weekly.  Tonics  are 
always  in  order.  Reconstructive  measures  should  be  instituted,  and  to 
this  end  we  may  employ  in  the  home  the  cold  sponge  or  the  dripping 
sheet  at  60°  F.  for  three  minutes,  applied  on  arising,  together  with  the 
use  of  the  hot  full  bath  at  100°  to  105°  F.  three  times  weekly  at  bed- 
time. In  conjunction  with  this  treatment  use  the  vaginal  douche  of 
normal  saline  solution  at  110°  to  115"  F.  night  and  morning,  or  once 
daily,  followed  by  a  tampon  of  ichthyol  or  chinosol  in  glycerine,  25 
per  cent.  These  cases  are  frequently  helped  by  the  use  of  the  Turkish 
bath,  but  it  should  be  cautiously  given  under  a  physician's  direction. 
By  far  the  best  measure  is  the  daily  use  of  the  superheated  dry  hot  air 
body  apparatus  for  thirty  to  sixty  minutes,  followed  by  the  horizontal 
rain  bath  at  75"  F.  for  fifteen  to  twenty  seconds,  to  be  immediately 
followed  by  the  cold  sitz  bath  at  60°  to  50° F.  for  two  to  five  minutes, 
accompanied  by  friction,  to  the  lower  abdomen,  inner  surfaces  of  the 
thighs  and  lower  back.  It  should  be  here  noted  that  after  the  use  of 
the  dry  hot  air.  no  warm  water  is  given  in  the  rain  bath.     Depending 


DISEASES  OE  WOMEN.  527 

upon  the  case,  we  may,  if  we  s<>  desire,  in  place  of  the  sitz  use  the  jet 
douche  at  60°  F.  to  the  lower  spine  and  posterior  aspect  of  the  lower 
limbs  for  ten  to  fifteen  seconds.  The  electric  light  bath  may  be  sub- 
stituted for  the  dry  hot  air,  but  the  author's  preference  is  for  the 
former.  Some  writers  have  found  the  neutral  bath  for  twenty  to 
forty  minutes,  three  times  weekly,  an  excellent  measure,  but  it  has 
failed  to  give  good  results  in  the  author's  experience.  Far  better  than 
the  neutral  bath,  where  institutional  treatment  cannot  be  carried  out, 
is  the  wet  half  pack,  pelvic  pack  or  the  trunk  compress  at  60°  F.  for 
thirty  to  sixty  minutes,  preferably  at  bedtime. 

Pelvic  Cellulitis  and  Pelvic  Peritonitis. 

Pelvic  cellulitis  is  an  inflammation  of  the  cellular  tissue  of  the 
pelvis  lying  behind,  in  front  of,  at  the  sides  of  the  uterus,  and  extending 
up  between  the  layers  of  serous  membrane  which  forms  the  broad 
ligaments.  Pelvic  peritonitis  is  an  inflammation  of  the  peritoneum 
surrounding  the  uterus  and  appendages.  These  conditions  are  fre- 
quently associated  together  or  complicate  each  other.  Cellulitis  is  an 
important  factor  in  inflammatory  lesions  of  the  pelvis.  Its  cause  is 
usually  streptococci  and  staphylococci,  more  commonly  the  former.  It 
is  frequently  associated  with  the  puerperal  state,  and  may  follow  labor 
at  term  or  after  an  abortion.  Many  of  those  cases  that  present 
violent  hypogastric  pain,  tenderness  and  vomiting  after  "catching  cold" 
just  about  the  menstrual  period  are  doubtless  cellulitis  or  peritonitis. 
Invasion  is  usually  by  the  lymphatics  along  the  layers  of  connective 
tissue  or  fascia  of  the  pelvis.  As  a  result  we  do  not  have  uniform, 
but  irregular  strata.  Entrance  is  usually  gained  through  a  laceration 
or  abrasion  in  the  genital  tract  or  from  some  placental  debris  in  the 
uterine  cavity.  The  greatest  number  of  cases  follow  the  folds  of  the 
broad  ligaments.  The  exudate,  while  soft  and  spongy  at  the  start, 
soon  assumes  its  characteristic  "boardiness"  or  stony  hardness  and 
immobility.  There  is  a  tendency  to  suppuration,  and  pus,  in  seeking 
an  exit,  may  cause  fistulae.  This  is  a  congenial  soil  for  pus  bacteria. 
It  ordinarily  runs  its  course  in  two  to  fourteen  weeks.  Pelvic  periton- 
itis and  pelvic  abscess  frequently  complicate.  If  an  abscess  forms 
surgery  is  the  only  relief.  It  is  manifested  by  pain,  tenderness, 
tympanites,  temperature,  nausea,  vomiting  and  anxious  facies. 

The  importance  of  avoiding  inflammation  of  the  cellular  tis- 
sue and  peritoneum  cannot  be  too  much  emphasized ;  this  in- 
volves surgical  and  post-partum  cleanliness.  Women  should  seek 
to  maintain  good  general  health,  avoid  exposure  both  before  and  after 
menstruation,  damp  and  wet  feet  in  cold  wet  weather,  and  provide 
themselves  with  sufficient  clothing,  especially  warm  stockings  and  thick 
low-heeled  shoes.  Once  cellulitis  and  peritonitis  have  commenced 
absolute  perfect  quiet  and  rest     must  be  observed.     This  means  rest 


528  PRACTICAL    HYDROTHERAPY. 

in  bed  with  the  hips  elevated,  a  trained  nurse  in  attendance,  and  at- 
tendance to  the  calls  of  nature  by  the  bed-pan.  The  diet  should  be 
liquid  and  salines  given  in  one  drachm  doses  hourly  until  free  purga- 
tion. This  should  be  maintained,  and  in  addition  a  hot  normal  saline 
enema  given  once  or  twice  daily.  In  order  to  heighten  the  general 
resistive  powers  of  the  body  in  its  fight  against  the  infection,  the  cold 
sponge  may  be  administered  at  75°  to  65°  F.  once  or  twice  daily.  Local 
treatment  is  of  decided  value,  and  embraces  the  use  of  the  hot  normal 
saline  vaginal  douche  at  110°  to  120°  F.,  one  to  two  gallons  in  quantity, 
three  to  four  times  daily,  to  be  immediately  followed  by  the  applica- 
tion of  the  fomentation  at  130°  to  160°  F.  for  ten  minutes,  it  in  turn 
to  be  followed  by  the  ice-bag  to  the  hypogastrium  or  the  cold  compress 
over  the  hypogastrium  and  inner  surfaces  of  the  thighs.  During  the 
application  of  the  ice-bag  or  compress  the  hot-water  bag  should  be 
applied  to  the  feet.  Every  two  or  three  hours  the  treatment  above 
outlined  must.be  repeated  and  the  interval  gradually  lengthened  with 
the  patient's  improvement. 

In  the  chronic  stage  the  most  satisfactory  method  is  a  combination 
of  general  and  local  measures,  of  which  the  following  has  proven  very 
satisfactory  to  the  author:  As  soon  as  the  patient  is  convalescent  and 
up  and  about  we  may  discontinue  the  cold  sponge  and  use  in  its  place 
the  electric  light  bath  to  point  of  free  perspiration,  or  the  superheated 
dry  hot  air  body  apparatus  at  200°  to  300°  F.  for  twenty  to  forty 
minutes.  These  procedures,  of  which  the  writer  believes  the  latter  to 
be  the  better,  are  to  be  followed  by  the  horizontal  rain  bath  at  100°  to 
104°  F.  for  one  minute,  reduced  to  65°  F.  for  one-fourth  minute, 
pressure  twenty-five  to  thirty  pounds,  followed  by  the  cold  sitz  bath  at 
65°  to  50°  F.  for  two  to  five  minutes,  with  vigorous  friction,  to  the 
hypogastrium  and  inner  surfaces  of  the  thighs  by  the  patient  and 
lower  back  and  hips  by  the  attendant.  As  soon  as  possible  we  should 
commence  the  use  of  the  following  treatment,  which  can  only  be 
applied  to  patients  who  are  in  good  condition  and  whose  reaction  is 
prompt  and  strong :  Electric  light  bath  as  above ;  horizontal  rain  bath 
at  105°  F.  for  one  and  one-half  minutes,  pressure  twenty-five  pounds, 
followed  by  the  jet  douche  to  the  spine  and  posterior  aspect  of  the 
lower  limbs  at  65°  F.  for  ten  seconds,  followed  by  the  fan  douche  to 
the  entire  body  at  the  same  temperature.  During  the  day,  preferably 
at  night  and  in  the  morning,  we  should  continue  the  hot  vaginal  douche, 
using  one  gallon  of  normal  saline  solution.  Where  the  above  treat- 
ment cannot  be  carried  out  the  following  may  be  instituted :  A  fomenta- 
tion to  the  hypogastrium  and  inner  surfaces  of  the  thighs  at  150°  to 
160°  F.  for  ten  minutes,  repeated  for  ten  minutes,  followed  by  the 
coid  wet  half  pack,  pelvic  pack  or  stimulating  compress  at  60°  F., 
applied  from  the  middle  of  the  thighs  to  epigastrium,  for  thirty  to 
sixty  minutes.     Where  there  is  pain  in  the  chronic  stage  of  the  disease 


DISEASES  OE  WOMEN.  529 

relief  will  he  frequently  obtained  by  the  use  of  the  fomentation  at  150° 
to  160°  F.  for  ten  minutes,  followed  by  the  application  of  the  ice-hag 
over  a  compress  to  the  painful  spot.  In  this  stage  Kellogg3  has  sug- 
gested the  use  of  the  alternating  vaginal  douche,  the  temperature  vary- 
ing from  110°  to  70°  F.  In  the  author's  very  limited  experience  with 
this  method  fair  results  have  been  obtained. 

Pelvic  Pain  and  Pelvic  Congestion. 

There  are  certain  conditions  of  pelvic  pain  that  seem  to  be  present 
without  apparent  lesion,  that  are  of  a  neuralgic  or  congestive  character, 
and  to  these  the  general  term  of  pelvic  pain  may  be  applied.  This 
conclusion  must  be  reached  by  exclusion  of  all  other  known  causes  that 
would  produce  the  pain. 

The  essential  element,  of  course,  would  be  to  remove  all 
known  causes,  such  as  tight  bands,  corsets,  heavy  skirts,  tight  shoes, 
exposure  to  wet  weather,  sexual  excess,  etc.  Where  present,  anemia, 
chlorosis,  neurasthenia,  hysteria,  constipation,  etc.,  are  to  be  treated, 
the  key-note  being  to  build  up  the  general  health.  The  pain  and  con- 
gestion in  the  acute  stage  can  best  be  overcome  by  rest  in  bed,  free 
purgation  with  salines,  such  as  Epsom  or  Crab  Orchard  salts,  and 
the  use  of  the  following  measures :  A  hot  vaginal  douche  of  one  gallon 
of  normal  saline  solution,  followed  by  the  hot  sitz  bath  to  the  point  of 
toleration,  usually  between  110°  and  115°  F. ;  the  patient  is  then  put 
to  bed  and  the  hot-water  bag  applied  to  the  feet,  and  if  congestion  is 
present  the  ice-bag  over  the  seat  of  pain.  When  the  patient  is  up  we 
may  institute,  with  positive  assurance  of  success,  the  general  tonic 
and  local  measures  that  have  just  been  mentioned  in  the  consideration 
of  the  chronic  stage  of  cellulitis  and  peritonitis. 

Sterility. 

Sterility  is  the  inability  on  the  part  of  a  woman  to  bring  forth  a 
living  child.  It  includes  women  who  cannot  conceive ;  those  that  can 
conceive,  but  cannot  carry  the  fetus  to  a  viable  age,  and  hence  abort ; 
and  those  who  have  borne  one  or  more  children  but  have  ceased  to  be 
fruitful.  The  essential  of  child-bearing  is  the  normal  position  of  the 
ovule  and  spermatozoa,  endowed  with  those  wonderful  physiological 
properties  that  result  in  the  development  and  growth  of  the  fetus. 
Many  ovules  traverse  the  tubes  and  thousands  of  spermatozoa  perish 
before  they  reach  their  normal  destination.  On  the  part  of  the  woman 
the  genital  organs  may  be  infantile;  the  ovule  may  not  be  formed  from 
want  of  development  or  previous  disease ;  the  tube  may  be  closed, 
bound  down  or  distorted  ;  the  uterine  secretions  may  be  poisonous ; 
the  uterine  membrane  diseased ;  mechanical  obstacles  in  the  uterus ; 
injurious  vaginal  secretions ;  expulsion  of  the  semen  by  vaginal  con- 

3   Kellogg,  J.   H.:   "Rational   Hydrotherapy,"   1906. 


530  PRACTICAL    HYDROTHERAPY. 

tractions,  and  bad  health.  Some  women  normally  conceive  poorly, 
others  readily.  Frequently  the  cause  lies  in  the  male.  About  one  in 
every  eight  or  ten  marriages  are  sterile.  Syphilis  is  particularly 
inimical  to  fetal  viability.  The  prognosis  depends  on  the  cause;  if 
organic  and  impossible  to  overcome,  there  is  no  hope ;  these  are  few. 
If  recognizable,  the  cause  should  be  removed.  On  the  whole,  few 
women  remain  sterile  all  their  lives ;  many  bear  children  after  long 
years  of  sterility,  and  some  several  in  succession. 

The  first  thing  to  be  done  is  to,  as  far  as  possible,  remove 
all  local  causes,  such  as  inflammation ;  dilate  the  canal,  straight- 
ening same  and  overcoming  malposition.  General  conditions  of  gout, 
rheumatism,  lithemia,  lead  and  syphilis  must  be  removed.  All  meas- 
ures are  to  be  followed  out  patiently,  and  success  will  only  be  secured 
where  they  are  persevered  in.  General  and  local  measures  are  best 
combined  as  follows :  Electric  light  bath  to  perspiration,  or  the  super- 
heated dry  hot-air  body  apparatus,  thirty  to  sixty  minutes,  followed 
by  the  horizontal  rain  bath  at  102°  to  104°  F.  for  one  to  two  minutes, 
reduced  to  80°  to  65°  F.  for  one- fourth  minute,  pressure  twenty-five 
to  thirty  pounds,  followed  by  the  cold  sitz  bath  at  60°  to  50°  F.  for  two 
to  five  minutes,  with  friction  to  the  parts  immersed.  The  temperature 
of  the  rain  bath  should  be  reduced  two  to  three  degrees  daily  until 
60°  F.  is  reached.  As  soon  as  the  patient's  reactive  power  is  improved 
we  may  follow  the  rain  bath  with  the  jet  douche  at  60°  F.  to  the  middle 
and  lower  spine  for  ten  to  fifteen  seconds,  pressure  twenty-five  to 
thirty  pounds,  followed  by  the  cold  sitz  bath  as  above.  The  vaginal 
douche  of  normal  saline  solution,  at  110°  to  120°  F.,  morning  and  night 
and  before  intercourse,  neutralizes  the  acid  discharges,  cleanses  the 
parts,  stimulates  circulation  and  relieves  inflammation.  These  meas- 
ures, in  conjunction  with  nutritious  diet,  exercise  and  attention  to  any 
defect  in  the  general  health,  will  usually  prove  sufficient. 

Menopause. 

The  menopause,  the  climacteric,  the  "critical  period,"  the  "change 
of  life,"  is  that  epoch  in  a  woman's  life  characterized  by  a  cessation 
of  menstruation  and  the  ability  to  bear  children.  Women  can  no 
longer  stand  the  wear  and  tear  nor  the  drain  of  child-bearing  and 
menstruation,  so  Nature  kindly  closes  this  function  as  a  protection 
to  the  female  and  to  the  virility  of  the  child.  It  usually  occurs  be- 
tween the  forty-fifth  and  fiftieth  years,  sometimes  much  earlier,  some- 
times later.  This  is  often  a  family  trait.  Early  puberty,  late  meno- 
pause ;  late  puberty,  early  menopause,  is  the  usual  rule.  It  occurs 
earlier  in  cold  than  in  warm  climates,  earlier  in  the  fat  and  weak, 
earlier  in  the  nulliparae  than  in  those  who  have  borne  children.  Its 
onset  is  usually  gradual,  lasting  from  two  to  three  or  more  years. 
In  some  cases  it  is  sudden,  the  menses  stopping  never  to  return.     Dur- 


DISEASES  OF  WOMEN.  531 

ing  the  menopause  atrophic  changes  take  place ;  the  vulva  flattens  and 
thins;  the  vagina  atrophies  and  shortens;  the  uterus  becomes  small, 
the  cervix  is  gradually  absorbed,  the  Fallopian  tubes  and  ovaries 
shrink  and  finally  disappear ;  the  breasts  flatten  and  become  flabby ; 
the  contour  of  the  body  becomes  matronly  and  the  abdomen  enlarges. 
The  normal  menopause  should  be  attended  with  few  local  or  general 
symptoms,  but  the  woman  of  to-day  generally  suffers  severely  with 
circulatory  symptoms,  vasomotor  in  character,  such  as  hot  flushes 
of  the  face  and  body,  with  sweating  or  chilliness  afterward,  fullness 
of  the  head,  headache,  indistinct  vision,  insomnia,  vertigo,  cold  hands 
and  feet,  epistaxis  and  other  hemorrhages.  The  nervous  system  is 
involved,  the  woman  becoming  irritable,  hysterical,  nervous,  depressed, 
fearful,  with  neuralgias  in  the  various  parts  of  the  body,  pruritus, 
numbness,  formications,  sometimes  melancholia  and  insanity.  In 
some  the  sexual  passion  is  much  stimulated.  The  digestive  apparatus 
suffers  intensely,  with  dyspepsia,  torpid  liver,  constipation,  flatus,  at 
times  diarrhea.  Uterine  hemorrhage  calls  for  prompt  investigation, 
as  women  are  prone  at  this  time  to  regard  same  as  a  part  of  the  change. 
It  is  nearly  a  sure  index  of  pathological  change,  and  carcinoma  should 
always  be  feared. 

With  the  commencement  of  this  epoch  of  a  woman's  life 
she  should  begin  to  lead  an  existence  that  is  generally  encompassed 
under  the  term  simplicity.  Her  time  should  be  engaged  in  light 
work,  diversion  and  pleasure ;  her  diet  plain  and  frugal,  though 
nutritious,  with  little  tea  and  coffee,  no  malt  or  alcoholic  liquors. 
Free  water-drinking  is  of  great  benefit,  provided  arterial  sclerosis  is 
not  present.  Laxatives,  with  an  occasional  saline,  will  be  found  ben- 
eficial. Very  moderate  exercise  in  the  fresh  air,  of  which  driving  is 
the  best,  is  to  be  indulged.  Of  all  the  methods  of  overcoming  the 
difficult  and  disagreeable  features  of  the  menopause,  hydrotherapy  is 
the  most  valuable  single  weapon,  because  of  its  physiological  action. 
Upon  the  nervous  system  it  acts  as  a  tonic,  sedative  and  stimulant ; 
upon  elimination,  removing  the  products  of  defective  metabolism ;  it 
increases  secretion,  corrects  digestive  disturbances  and  diseases ;  it 
heightens  mentality,  gives  to  the  individual  an  exhilaration  equalled 
by  nothing ;  and  finally  upon  the  heart,  circulation  and  vasomotor 
mechanism,  it  so  tones,  stimulates  and  restrains  their  action  that  the 
disagreeable  palpitation,  flushes,  fullness,  etc.,  disappear. 

In  the  home,  and  particularly  where  the  woman  is  a  stranger  to 
cold  water,  we  may  commence  with  the  daily  cold  sponge,  best  taken 
upon  arising,  starting  at  a  temperature  of  90°  F.,  reduced  two  degrees 
daily  to  60°  F.  Gradually  make  the  cloth  wetter  and  wetter  as  the 
reaction  improves.  Follow  the  sponge  with  vigorous  friction  with 
a  coarse  crash  towel.  Where  a  member  of  the  family  can  be  pressed 
into    service,    we    may,    when    reaction    is    established,    substitute   the 


532  PRACTICAL    HYDROTHERAPY. 

dripping  sheet,  well  wet,  at  a  temperature  of  60°  F.  for  three  min- 
utes, accompanied  by  vigorous  friction  and  the  after-use  of  the  crash 
towel  to  promote  reaction.  Three  times  during  the  week  the  patient 
takes  a  full  hot  bath  at  100°  to  102°  F.,  following  it  with  one  of  the 
above-named  treatments,  or,  what  is  better,  the  cold  shower  at  a  tem- 
perature of  60°  to  50°  F.  for  one-fourth  to  one-third  minute.  In 
cities  the  use  of  the  Turkish  bath  once  or  twice  weekly  will  be  found 
satisfactory,  provided  it  is  taken  under  the  guidance  and  direction  of 
a  physician. 

These  cases  are  by  far  best  treated  in  sanatoria  or  hydrotherapeutic 
institutions  in  the  following  manner :  Electric  light  bath  to  free  per- 
spiration, followed  by  the  horizontal  rain  bath  at  100°  to  104°  F.  for 
one  and  one-half  minutes,  reduced  to  80°  F.  for  one-fourth  minute, 
pressure  twenty-five  pounds.  Reduce  the  temperature  two  to  three 
degrees  daily  to  60°  F.,  following  the  bath  with  vigorous  friction  to 
secure  reaction,  treatment  to  be  given  three  to  six  times  weekly.  At 
the  earliest  possible  moment  use  the  jet  douche  at  a  temperature  of 
60°  F..  pressure  twenty-five  pounds,  for  ten  to  twenty  seconds,  applied 
to  the  spine  and  posterior  aspect  of  the  lower  limbs.  The  author's 
preference  is  decidedly  in  favor  of  the  electric  light  bath  in  this  con- 
dition as  a  form  of  heating  procedure,  as  he  has  found  it  to  be  rather 
a  specific  in  its  tonic,  stimulating  properties.  It  is  an  artificial  sun- 
shine which  these  women  so  often  need. 

Certain  special  indications  oftentimes  require  to  be  met : 

To  improve  the  digestion,  we  may  employ  Neptune's  girdle  worn 
during  the  entire  night,  and  should  an  attack  of  intercurrent  diarrhea 
occur  the  sitz  bath  at  65°  to  50°  F.,  with  friction  to  the  lower  abdomen. 

For  insomnia  nothing  is  superior  to  the  full  neutral  bath  at  94°  to 
92°  F.  for  thirty  to  sixty  minutes  at  bedtime,  or  the  use  of  the  full  wet 
pack  at  65°  F.  for  one  hour  just  before  retiring. 

For  the  treatment  of  distressing  pruritus,  reference  should  be  made 
to  the  section  in  which  this  is  considered. 

For  increased  sexual  desire  the  sitz  bath  at  92°  to  94°  F.  for 
twenty  to  forty  minutes  at  bedtime,  or  the  full  neutral  bath  will  be 
found  most  satisfactory. 

For  local  manifestations,  hot  douches  of  normal  saline  solution  and 
the  use  of  glycerine  tampons  will  give  much  comfort.  Medicinal 
measures,  such  as  bromides,  ovarian  and  thyroid  extracts,  grains  one 
to  five  daily,  have  proven  useful. 


CHAPTER  XXIV. 

GENITO-URINARY  DISEASES  AND  SYPHILIS;  DISEASES 
OF  THE  RECTUM. 

Urethritis;  Gonorrhea. 

Gonorrhea  is  a  specific,  contagious  inflammation,  usually  of  the 
mucous  membrane  of  the  urethra  or  vagina,  accompanied  by  a  muco- 
purulent discharge,  capable  of  communicating  the  disease  to  other 
mucous  membranes.  It  is  a  true  specific  urethritis,  though  non- 
specific urethritis  may  be  set  up  by  sexual  contact  with  one  suffering 
from  the  disease :  it  is,  in  rare  instances,  transmitted  by  contaminated 
objects.  The  virulence  of  the  infection  varies;  it  is  usually  surface 
in  character,  and  involves  principally  the  epithelial  layer.  The  in- 
flammation starts  at  the  meatus  and  extends  backward  rapidly,  and  is 
characterized  by  a  profuse  yellow  pus,  pain,  tenderness  ardor  urinse. 
chordee.  etc.  In  specific  cases  the  gonococcus  is  usually  present, 
stains  readily  with  methyl  blue,  and  is  decolorized  by  Gram's  method. 
In  women  the  urethra,  vulva,  vagina  and  cervix  uteri  are  involved. 
Specific  infection  by  the  gonococcus  is  the  most  prolific  cause  of 
inflammatory  diseases  of  the  pelvic  organs  of  the  female.  Its  sequelae 
in  the  male  are  many,  especially  inflammatory  conditions  of  the  deep 
urethra,  vesicles,  etc.  Age  and  severe  attacks  confer  a  certain 
immunity. 

The  important  element  in  treatment  is  cleanliness  prevention 
of  the  spread  of  the  infection  and  destruction  of  the  specific 
micro-organism.  The  diet  should  be  low.  non-stimulating — that  is 
to  say,  practically  free  from  meat.  Large  quantities  of  water, 
plain  and  carbonated,  in  which  may  be  dissolved  potassium  acetate, 
citrate,  or  bitratrate,  should  be  drunk.  An  excellent  combination  is 
the  use  of  one  of  these  alkalis  with  spiritus  aether  nitrosi,  freely  given 
so  as  to  render  the  urinary  secretions  alkaline,  allay  irritation  and 
increase  its  flow.  Methylene  blue  may  be  given,  as  it  assists  in  de- 
stroying germs ;  sexual  excitement  should  be  forbidden  and  hydro- 
therapy immediately  instituted.  This  disease  is  best  met  by  the 
frequent  immersion  of  the  parts  in  as  hot  water  as  can  be  borne, 
together  with  the  use  of  local  irrigation.  Permanganate  of  potassium. 
1:3000  to  1:1000,  at  a  temperature  of  120c  to  130°  F..  and  the  very 
hot  sitz  bath  (  105°  to  115°  F.)  for  ten  to  twenty  minutes  will  prove 
especially  efficacious  in  the  relief  of  pain  and  in  diminishing  the  dis- 
(533) 


534  PRACTICAL    HYDROTHERAPY. 

charge.  In  the  female  the  vaginal  douche,  three  to  four  quarts  of 
very  hot  normal  saline  solution,  even  to  130°  F.  if  it  can  be  borne,  is 
the  treatment  par  excellence,  as  the  germ  is  killed  by  a  temperature 
above  118°  F.  An  excellent  method  is  the  use  morning  and  night  of 
1:1500  to  1:500  permanganate  of  potassium  solution,  with  the  hot 
normal  saline  solution  every  two  to  three  hours  between  times.  After 
the  douche  the  sitz  above  described  should  be  used.  Where  chordee 
exists  the  cold  compress  or  the  ice-bag  may  be  applied  for  the  length 
of  time  that  is  needed  to  control  the  trouble. 

In  the  chronic  stage  the  prostatitis,  vesiculitis  and  urethritis  must 
be  met;  the  reader  is  referred  to  these  sections  for  further  information. 
In  the  chronic  stage  of  the  disease  recovery  can  be  materially  aided 
by, the  use  of  the  psychrophore  of  Winternitz  for  ten  to  fifteen 
minutes  at  a  temperature  of  50°  to  60°  F.,  or  an  alternating  tem- 
perature may  be  employed  ranging  from  105°  to  50°  F. 

Epididymitis. 

Epididymitis  is  an  inflammation  of  the  epididymis,  usually  in- 
flammatory in  character,  but  may  be  syphilitic  or  tubercular.  With 
the  last-mentioned  the  general  treatment  of  tuberculosis  and  surgical 
measures  are  indicated.  Sterility  is  the  usual  result.  The  syphilitic 
variety  requires  the  measures  mentioned  under  this  head.  It  most 
commonly  results  by  the  extension  of  gonorrheal  inflammation  through 
the  sac  to  the  epididymis.  The  cord  is  swollen  and  tender,  there  is 
pain  in  the  back,  the  testicle  swells,  is  tender  and  walking  is  difficult. 
Suppuration  rarely  occurs ;  resolution  is  most  common,  although 
traces  remain  for  long  times,  as  shown  by  the  irregular  outline  of 
the  organ. 

Where  any  serious  inflammation  exists,  epididymitis  is  dan- 
gerous, in  that  it  may  render  the  individual  sterile,  and  for  that 
reason  demands  more  careful  attention  to  its  handling  than  it  is 
usually  accorded.  Rest  in  bed  should  be  enjoined,  and  salines,  such 
as  Rochelle  or  Crab  Orchard,  prescribed  to  the  point  of  purgation. 
The  diet  must  be  restricted  and  low,  from  which  all  meat,  meat  ex- 
tracts and  soups  are  removed.  Water  should  be  freely  drunk  and 
alkaline  antiseptic  diuretics  administered.  The  best  treatment  is  the 
hot  sitz  bath  at  105°  to  110°  F.  for  ten  to  twenty  minutes,  two  to 
three  times  daily,  followed  by  the  cold  stimulating  compress  at  60° 
to  50°  F.,  or  the  ice-bag.  Where  the  sitz  cannot  be  used  the  fomenta- 
tion at  130°  to  160°  F.,  applied  for  ten  minutes,  repeated  for  ten 
minutes  and  followed  by  the  compress  or  ice-bag,  will  be  found  an 
excellent  method  of  allaying  inflammation.  In  some  cases  the  wetting 
of  the  compress  with  lead  and  opium  wash  will  materially  aid  in 
allaying  pain. 


GENITO-URINARY  DISEASES  AND  SY I'll I LIS.       535 

Orchitis. 

Orchitis  is  an  inflammation  of  the  testicle,  caused  most  usually 
by  extension  of  gonorrheal  infection  or  traumatism.  Parotitis,  syphilis 
and  tuberculosis  occasionally  produce  the  inflammation.  The  last  two 
require  specific  measures  enumerated  under  other  headings.  Orchitis 
is  usually  characterized  by  dull,  sickening  pain,  radiating  to  the  back 
and  hips,  swelling,  tenderness,  difficulty  of  locomotion,  etc.  Xausea 
is  frequently  present.  Suppuration  rarely  results,  sterility  fairly 
often.  There  is  no  difference  in  the  treatment  between  the  metastatic 
form   accompanying  mumps   and   the   inflammatory  variety. 

The  patient  should  be  confined  in  bed  and  forbidden  to  stand 
much  or  walk  about.  The  scrotum  is  suspended  by  means  of 
a  gauze  band  attached  to  another  band  encircling  the  body.  Saline 
laxatives,  Epsom,  Rochelle  or  Crab  Orchard,  in  full  doses  to  catharsis. 
The  diet  must  be  limited  and  meats  excluded  entirely.  Alkaline  and 
antiseptic  diuretics  given,  well  diluted  with  water,  until  the  urine  is 
distinctly  alkaline.  The  most  satisfactory  treatment  is  the  following: 
Morning  and  night  the  hot  sitz  bath  at  105°  to  115°  F.,  if  possible, 
for  ten  or  fifteen  minutes,  after  which,  the  compress  dipped  in  a 
solution  of  lead  and  opium  or  lead  and  laudanum  is  applied  over  the 
affected  parts,  over  which  the  ice-bag  is  placed.  Every  two  or  three 
hours  the  compress  and  ice-bag  are  removed  and  the  fomentation 
at  130°  to  160°  F.  is  applied  for  ten  minutes,  repeated  for  ten  minutes, 
to  be  again  in  its  turn  followed  by  the  medicated  compress  and  the 
ice-bag.  Abscess  and  hydrocele  require  surgical  measures.  In  the 
chronic  stage  general  measures  are  demanded,  of  which  the  best  is 
.the  following:  Electric  light  bath  or  hot-air  bath  to  point  of  free 
perspiration,  followed  by  the  horizontal  rain  bath  at  100°  to  104°  F. 
for  one  to  two  minutes,  reduced  to  80°  F.  for  one-fourth  minute, 
pressure  thirty  pounds.  Reduce  the  cold  water  two  degrees  daily  to 
60°  F.  As  soon  as  the  patient  is  able  and  his  reaction  justifies  it, 
finish  the  above  treatment  with  the  jet  douche  to  the  spine  at  60°  F. 
for  ten  seconds  and  the  fan  douche  to  the  body  for  ten  seconds. 
Where  it  is  not  possible  to  secure  the  above  treatment,  the  full  hot 
bath  may  be  employed,  followed  by  the  dripping  sheet  at  65°  to  50°  F. 
for  three  minutes,  with  vigorous  friction.  A  suspensory  bandage 
should  be  worn.  If  general  or  localized  areas  of  hard  and  inflam- 
matory tissue  remain,  they  may  be  anointed  with  the  unguentum 
hydrargyrum. 

Prostatitis,  Acute  and  Chronic. 

Prostatitis  is  an  inflammation  of  the  prostate,  usually  follicular, 
sometimes  parenchymatous.  It  is  characterized  by  heat  and  fullness 
in  the  perineum,  frequent  urination,  pain  in  varying  degree,  tenesmus, 
congestion    and    enlargement   of    the   gland.        The   parenchymatous 


536  PRACTICAL    HYDROTHERAPY. 

variety,  in  which  all  the  structures  are  involved,  is  usual1/  more  severe 
in  its  manifestations,  fever  and  increased  pulse  rate  being  present. 
Both  forms  usually  follow  a  posterior  urethritis,  generally  of  gonor- 
rheal origin,  the  onset  being  sudden.  Physical  examination  settles 
the  diagnosis. 

This  is  a  disease  that  cannot  be  trifled  with,  owing  to  the 
serious  consequences  that  are  apt  to  follow  inflammation  of  the 
prostate  gland.  Depending  upon  the  seriousness  of  the  attack, 
we  may  insist  upon  rest  in  bed,  upon  liquid  and  low  diet,  of  which 
iced  milk  and  iced  water  alternately  every  three  hours  is  by  far  the 
best  treatment.  The  minimum  water  that  should  be  drunk  during 
twenty-four  hours  is  one  gallon.  Catharsis  must  be  induced  by  salines 
and  the  urine  rendered  alkaline  by  the  use  of  acetate,  citrate  or 
bitartrate  of  potassium,  the  hips  being  elevated  by  means  of  a  pillow. 
Irrigation  of  the  bowel  and  bladder  with  hot  normal  saline  solution 
will  go  a  long  way  toward  relieving  suffering  and  discomfort.  Every 
four  hours  the  patient  should  be  given  a  hot  sitz  bath  at  105°  to 
110°  F.,  if  possible  115°  F.,  for  ten  or  twelve  minutes.  Should  this 
treatment  fail  to  relieve  the  suffering  and  lessen  the  inflammation, . 
the  administration  each  hour  of  the  fomentation  at  130°  to  160°  F., 
applied  to  the  perineum,  will  almost  surely  give  relief. 

Chronic  Prostatitis. 

Chronic  prostatitis  is  characterized  by  the  occasional  discharge  of 
a  clear  viscid  fluid,  especially  after  an  evacuation  of  the  bowels ;  fre- 
quent urination,  dull  pains  in  the  perineum,  in  the  loins,  some  perineal 
tenderness,  sensitiveness  to  pressure  from  the  rectum,  mental  anxiety 
and  depression.  The  urine  is  usually  cloudy,  and  contains  muco- 
purulent shreds  and  epithelium  from  the  prostate.  It  may  become 
the  nidus  for  reinfection,  causing  lingering  gonorrhea ;  may  cause 
sexual  neurasthenia,  impotence,  sterility.  Patients  who  have  had  this 
disease  following  gonorrhea  should  have  a  most  careful  examination 
of  the  secretions  stripped  from  the  prostate  for  fear  of  infection  of 
the  wife.  It  is  often  a  sequel  of  acute  gonorrhea,  but  may  develop 
slowly  and  insidiously.  Sometimes  improper  instrumentation,  irri- 
tating injections,  hemorrhoids  and  foreign  bodies  start  the  trouble. 
Attenuated  pyogenic  infection  has  been  noted  as  producing  a  mild 
form. 

These  cases  are  nearly  always  much  run  down  and  there- 
fore demand  general  attention.  The  diet  should  be  generous 
and  free  from  pepper,  vinegar,  mustard,  pickles,  tomatoes,  and  too 
much  meat ;  moderate  exercise  in  the  open  air  and  the  free  drinking 
of  water  are  to  be  insisted  upon.  The  urine  must  be  made  sterile 
and  antiseptic  by  the  use  of  urotropin.  Sexual  continence  is  a  sine 
qua    noii.      General   tonic   hydrotherapeutic   measures    should   be   em- 


GENITO-URINARY  DISEASES  AND  SYPHILIS.       537 

ployed — the  electric  light  bath  to  moderate  perspiration,  followed  by 
the  rain  bath  at  100°  to  104°  F.  for  one  minute,  reduced  to  80°  F. 
for  one-fourth  minnte,  pressure  twenty  pounds;  reduce  the  tem- 
perature two  degrees  daily  to  60°  F.  and  increase  the  pressure  one 
pound  daily  until  thirty  is  registered.  'Ibis  treatment  should  be 
followed  by  one  of  the  following  two  methods:  Either  the  cold  sitz 
bath  at  60°  to  50°  F.  for  five  to  ten  minutes,  with  friction,  applied 
to  the  inner  surfaces  of  the  thighs,  lower  abdomen  and  back,  or  the 
perineal  douche  for  one  to  two  minutes  at  55°  to  45°  F.  with  strong 
pressure.  This  latter  treatment  causes,  reflexly,  contraction  of  the 
blood-vessels  of  the  prostate,  and  in  this  way  relieves  congestion. 
The  following  combination  has  yielded  in  a  number  of  cases  the  best 
results :  The  prostate  is  massaged  two  or  three  times  weekly ;  the 
electric  light  bath,  rain  bath  and  perineal  douche  as  above  described, 
administered  daily.  This  results  in  an  emptying  of  the  ducts  of  the 
prostate,  improves  the  circulation  and  causes  the  absorption  of  the 
inflammatory  deposits.  Results  are  almost  immediately  noticed  in  the 
relief  of  nervous  depression,  weakness  and  the  sense  of  weight  and 
tenderness  in  the  prostatic  region.  A  hot  normal  saline  enema  at  105° 
to  120°  F.,  administered  at  bedtime,  will  oftentimes  relieve  the  dis- 
comfort, as  will  the  alternating  hot  and  cold  irrigation  of  the  rectum 
by  means  of  a  properly  constructed  irrigator.  Where  the  above 
treatments  cannot  be  carried  out  the  following  will  sometimes  prove 
of  considerable  value :  The  hot  trunk  pack  applied  from  the  middle 
of  the  thigh  to  the  epigastrium  at  120°  to  130°  F.  for  thirty  minutes, 
to  be  followed  by  the  ice-bag  to  the  perineum  for  fifteen  to  thirty 
minutes. 

Spermatorrhea;  Sexual  Neurasthenia. 

Under  this  term  we  group  true  spermatorrhea,  diurnal  and  noc- 
turnal emissions,  and  the  false  spermatorrhea  of  defecation.  The 
frequent  evacuation  of  semen  in  the  waking  hours  and  in  the  absence 
of  coitus  or  mechanical  irritation  is  abnormal.  The  presence  of  this 
disease  can  only  be  absolutely  diagnosticated  by  microscopic  exam- 
ination, and  the  occasional  presence  of  spermatozoa  is  to  be  consid- 
ered of  no  importance.  True  spermatorrhea,  in  which  there  is  a 
passive  loss  of  semen  unattended  with  pleasurable  sensations,  is  in  my 
experience  a  rare  disease.  False  spermatorrhea,  which  takes  place 
habitually  after  or  during  defecation,  and  in  which  no  seminal  elements 
are  present,  is  the  cause  of  a  great  deal  of  mental  agony  on  the  part 
of  supersensitive  men.  This  fluid,  which  is  derived  from  the  mucous 
glands  of  the  urethra  and  prostate,  is  passed  while  straining  at  stool 
or  at  the  end  of  urination,  and  is  falsely  considered  to  be  semen.  The 
condition  often  produces  mental  depression,  neurasthenia,  hypochon- 
driacal state,  etc. 


538  PRACTICAL    HYDROTHERAPY. 

Seminal  emissions  may  be  diurnal  or  nocturnal,  most  commonly 
the  latter.  It  is  a  physiological  condition  within  certain  limits,  and 
is  to  be  expected  in  human  males  during  the  period  of  their  sexual 
activity,  provided  the  seminal  vesicles  are  not  otherwise  emptied.  So 
long  as  they  are  not  too  frequent  and  do  not  affect  the  general  health, 
they  are  mere  incidents  and  do  not  concern  the  physician.  If  the 
general  health  fails,  and  headache,  insomnia,  neuralgia,  loss  of  appe- 
tite and  genital  irritability  appear,  they  become  pathological.  Fre- 
quency as  to  normal  is  to  be  determined  by  the  personal  equation, 
the  general  health  being  the  guide.  Their  frequency  often  depends 
upon  cleanliness  of  mind,  the  avoidance  of  immoral  pictures,  the 
eschewing  of  lewd  and  lascivious  conversation  and  thoughts.  It  may 
be  roughly  gauged  at  from  seven  to  fourteen  days.  Some  by  nature 
rarely  have  emissions.  They  are  caused  by  onanism,  diseases  of  the 
spinal  cord,  neurasthenia,  debility,  anemia,  etc.  Heredity  is  a  factor, 
just  as  are  sexual  instincts  and  practices.  Gonorrhea  and  its  sequelae, 
local  diseases  of  the  genitalia  and  rectum,  may  produce  emissions. 

Onanism  may  be  here  considered.  It  constitutes  a  series  of  acts, 
deviating  from  normal  intercourse,  by  which  the  sexual  orgasm  is 
produced.  It  is  a  frequent  habit  with  men  and  women,  and  covers 
all  of  those  acts  embraced  under  the  terms  of  masturbation  (solitary 
self-pollution),  withdrawal  from  the  vagina,  coitus  in  os,  inter- 
mammas,  mechanical  friction  of  all  kinds,  and  psychic  imagery  without 
mechanical  aid.  Though  ancient  in  custom,  it  is  more  to  be  honored 
in  the  breach  than  in  the  observance,  for  it  is  degrading  and  dishon- 
orable. The  disastrous  results  are  much  over-rated,  and  are  more  to 
be  found  in  the  flaming  literature  of  the  quack  vampire  that  sucks 
the  blood  of  his  misguided  victim  than  in  stern  reality.  It  may  result 
from  instruction  by  elders;  from  irritations  arising  in  the  genital 
tract ;  in  others  from  psychological  conditions.  Harm  results  from 
too  frequent  repetition  of  the  act,  from  the  psychic  influence  that  re- 
sults, but  in  this,  as  in  spermatorrhea,  the  effect  upon  the  general  health 
is  the  guide.  The  female  may  perform  onanistic  and  copulative  acts 
many  times  more  frequently,  over  long  periods,  without  suffering  any- 
thing like  the  same  results  that  occur  to  the  male.  The  consciousness 
of  wrong-doing,  the  fear  of  consequences,  the  knowledge  of  the  degra- 
dation of  the  act,  have  more  to  do  with  results  than  the  physical  loss 
and  irritation.  Kraft-Ebing  says :  "It  injures  the  whole  sexual  foun- 
dation, the  basis  of  all  ideal  activities :  it  extinguishes  the  fire  of  sen- 
suality and  sensual  feeling,  the  most  powerful  incentive  to  the  putting 
forth  of  strength  in  both  individual  and  social  existence  in  the  world 
of  beauty  and  morality."  It  is  a  common  practice  among  the  insane 
and  idiotic.  Young  children,  youths  and  girls,  should  be  early  watched 
to  prevent  onanism,  and  taught  by  parents  and  educators  to  avoid 
entering  upon  a  habit  that  is  morally  bad.     The  mental  status  of  these 


GENITO-URINARV  DISEASES  AND  SYPHILIS.       539 

cases  is  such  that  it  detracts  from  their  capabilities  and  effectiveness. 
Neurasthenia   and   neurasthenoid    symptoms   usually   result. 

Sexual  excesses  are  common,  and  nothing  more  so  than  excessive 
coitus.  A  safe  guide  as  to  frequency  is  the  sense  of  well-being,  buoy- 
ancy, clearer  mind  and  greater  inclination  to  work  that  succeeds  the 
cohabitation.  The  reverse,  premature  ejaculation  and  weakness,  calls 
for  cessation  and  reduction.  Excess  is  purely  a  relative  term,  some 
men  possessing  great,  others  weak,  virile  powers,  so  that  individual 
capacity  must  govern  our  judgment.  Abnormal  stimulation,  mentally 
or  physically,  irritations  located  in  the  genitals,  prostate  or  in  the 
urethral  canal,  may  lead  to  excessive  coitus.  Restraint  of  sexual  pas- 
sion— excitement  without  gratification,  failure  of  gratification  by  nor- 
mal coitus — may  become  the  cause  of  seminal  emissions.  Thus  Na- 
ture's great  wisdom  is  shown,  that  the  extremes  of  prolonged  conti- 
nence and  excessive  coitus  produce  the  same  results.  It  teaches  that 
in  this,  as  in  all  functions,  sweet  moderation  must  govern.  Abnormal 
stimulation,  psychic  or  mechanical,  improper  reading  and  suggestive 
pictures,  should  not  form  part  of  or  pander  to  the  sexual  desire,  but 
it  should  spring  from  that  normal  mental  and  physical  necessity,  in- 
herent in  the  healthy  individual  of  either  sex,  that  finds  its  outlet 
in  natural  and  judicious  performance  of  the  act  of  sexual  congress. 
Both  sexes  are  better  for  reasonable  indulgence  and  gratification  of 
this  dominant  instinct,  and  where  failure,  excess  and  abnormality  ex- 
ist, disease,  misery  and  unhappiness  follow.  It  is  a  hidden  center 
from  which  many  troubles  originate,  and  the  physician  finds  it  out 
oftentimes  too  late  to  save  and  prevent  suffering — somatic  and  psychic. 

In  the  management  of  these  cases  the  physician  cannot  alone 
perform  his  function  as  such,  but  must  become  an  educator 
along  sexual  lines.  To  this  end  the  patient  must  be  instructed  with 
regard  to  vicious  habits,  indiscretions  corrected,  and  a  mental,  physi- 
cal and  sexual  hygiene  outlined.  The  diet  should  be  nutritious,  non- 
stimulating,  with  a  moderate  amount  of  meat  and  no  condiments. 
Alcohol  in  all  shapes  and  forms  is  to  be  absolutely  forbidden.  Exer- 
cise, especially  the  bicycle,  is  to  be  recommended,  provided  a  proper 
seat  is  secured  that  will  free  the  prostate  from  pressure.  The  bladder 
and  bowel  should  be  emptied  at  bedtime,  the  latter  by  means  of  an 
enema  if  necessary.  The  general  hydrotherapeutic  treatment  is  most 
important,  reconstructing,  as  it  does,  the  general  health,  and  is  often- 
times all  that  is  necessary  to  bring  about  recovery.  In  the  home  we 
may  employ  the  cold  sponge  at  60°  to  50°  F.,  applied  on  arising,  or 
the  cold  plunge  at  60°  F.  Hydriatists  commence  with  the  electric  light 
bath  to  free  perspiration,  followed  by  the  horizontal  rain  bath  at  100° 
to  102°  F.  for  one  or  two  minutes,  reduced  to  80°  F.  for  one-fourth 
minute,  pressure  twenty  pounds ;  reduce  temperature  of  cold  water 
two  degrees  to  60°   F.  and  increase  pressure  one  pound  daily  until 


540  PRACTICAL    HYDROTHERAPY. 

thirty  is  registered.  These  baths  should  be  followed  by  the  cold  sitz 
bath  at  60°  to  50°  F.  for  three  to  five  minutes,  accompanied  by  fric- 
tion to  the  parts  immersed.  When  the  patient's  reaction  is  estab- 
lished and  the  cold  water  of  the  rain  bath  has  been  reduced  to  60° 
F.,  we  may  add  to  the  above  the  Scottish  or  alternate  douche  at  102° 
to  104°  F.  for  one- fourth  to  one-half  minute,  reduced  to  60°  F.  for 
five  to  ten  seconds,  three  to  four  alternations.  Always  finish  this 
douche  with  a  cold  application  to  the  feet.  An  excellent  method  of 
treatment  is  the  folowing:  Electric  light  and  rain  bath  as  above  de- 
scribed, followed  by  the  jet  douche  at  60°  F.  to  the  spine  and  lower 
limbs  for  ten  seconds,  the  fan  douche  to  the  body  for  five  to  ten  sec- 
onds, and  the  perineal  douche  at  50°  to  45°  F.,  strong  pressure,  for 
one  to  two  minutes.  This  is  a  powerful  treatment,  and  should  not 
be  applied  unless  the  patient  reacts  promptly.  Where  there  is  great 
irritability  and  the  patient  seems  to  respond  poorly  to  even  gentle  gen- 
eral measures,  we  oftentimes  find  that  a  preliminary  course  of  treat- 
ment by  the  neutral  sitz  bath  at  92°  to  95°  F.  for  fifteen  to  thirty  min- 
utes will  prepare  the  patient  for  the  stronger  and  more  active  general 
measures. 

Local  treatment  should  embrace  the  removal  of  phimosis,  stricture, 
vesiculitis,  urethritis,  etc.,  as  well  as  the  correction  of  any  rectal  dis- 
ease, such  as  fissure,  fistula,  hemorrhoids,  etc.  An  excellent  local 
application  is  the  psychrophore,  using  water  at  a  temperature  of  70° 
to  50°  F.  for  two  to  five  minutes  daily.  The  cold  sound,  faradic  and 
galvanic  electricity,  the  application  of  medicaments  to  the  urethra, 
rectal  irrigation  with  hot  normal  saline  and  antiseptic  irrigation  of 
the  canal  will  be  at  times  indicated,  in  addition  to  the  above  treatment. 

Impotence. 

By  impotciitia  cociindi  we  mean  the  inability  on  the  part  of  the 
male  to  perform  the  act  of  copulation,  a  physiological  power  inherent 
in  every  normal  individual.  It  may  be  due  to  congenital  defects  (or- 
ganic impotence),  functional  disease,  psychic  states,  pathological  con- 
ditions, etc.  Deficiency  of  erection,  as  regards  quality  and  duration, 
local  irritations,  premature  ejaculation,  fear,  worry,  etc.,  may  prove 
effective.  In  ill-health,  in  weakness,  in  frail  and  delicate  persons, 
there  is  oftentimes  manifested  a  coldness  toward  the  opposite  sex. 
Intense  mental  preoccupation,  grief,  apprehension  and  financial  re- 
verses, may  act  as  temporary  causes.  Onanism,  prostatitis,  gonor- 
rhea, orchitis,  cystitis  and  sexual  neurasthenia  are  frequently  at  the 
bottom  of  the  disorder,  and  demand  attention.  It  may  be  stated  that 
the  height  of  pleasure  can  only  enter  into  the  act  of  sexual  congress 
where  congeniality  and  love  exists  between  the  two  normal  individuals 
concerned.  This  explains  the  impotence  that  follows  an  indifference 
or  repelling  coldness  on  the  part  of  either  partner. 


GEN ITO-URI NARY  DISEASES  AND  SYPHILIS.       541 

Irritable  weakness  or  irritable  impotence  is  a  condition  in  which 
the  erection  cannot  be  maintained  in  a  sufficiently  vigorous  and  lasting 
state  until  such  time  as  to  permit  the  performance  of  a  series  of  me- 
chanical acts  or  movements  within  the  vagina  necessary  to  produce 
a  normal  orgasm.  This  is  most  frequently  accompanied  by  premature 
ejaculation  before  introduction  or  just  after  entrance  is  effected. 
Rigidity  is  suddenly  lost;  shame,  a  sense  of  loss  of  manly  power  and 
disgrace  takes  place.  These  individuals  are  usually  neurotic  or  neu- 
rasthenic, nervous,  irritable  and  high-strung.  Hyperesthesia  and  con- 
gestion of  the  mucous  membrane  of  the  urethra  are  present.  A  pre- 
ceding gonorrhea  is  a  common  history. 

Paralytic  impotence,  in  which  no — or  at  best  an  imperfect — erec- 
tion takes  place,  is  the  common  form,  and  is  usually  accompanied 
by  paralysis  of  the  bulbo-cavernosa  and  weakness  of  the  general  mus- 
culature of  the  genital  tract.  Injuries  and  diseases  of  the  spinal 
cord,  syphilis,  anemia,  nerve  exhaustion,  tuberculosis,  nephritis,  and 
many  drugs  produce  the  condition.  The  prognosis  in  the  organic 
form  depends  on  surgical  possibilities;  the  paralytic  is  questionable. 
but  in  the  psychic,  functional,  irritable,  etc..  it  is  good. 

Measures  to  be  used  in  this  condition  will  be  determined 
largely  by  the  general  condition  producing  the  disease.  The 
hydrotherapeutic  treatment  is  satisfactory,  and  should  be  both  gen- 
eral and  local.  Commence  by  giving  the  electric  light  bath  until  mod- 
erate perspiration  ensues,  followed  by  the  horizontal  rain  bath  at 
100°  to  102°  F.  for  one  to  two  minutes.  Reduce  the  temperature 
two  degrees  daily  to  60°  F.  and  make  the  pressure  thirty  pounds. 
This  treatment  should  be  followed  by  the  cold  sitz  bath.  60°  to  50°  F., 
for  three  to  five  minutes.  As  soon  as  the  patient  has  established  an 
excellent  reaction  we  may  add  to  the  electric  light  bath  and  hori- 
zontal rain  bath  above  mentioned  the  jet  douche  to  the  spine  and  pos- 
terior aspects  of  the  lower  limbs  at  a  temperature  of  60°  F.  for  ten 
to  fifteen  seconds  under  a  pressure  of  thirty  pounds.  Especial  at- 
tention should  be  paid  to  the  lower  half  of  the  spine.  The  perineal 
douche  at  60°   F.  is  a  valuable  measure. 

Local  measures  that  have  proven  satisfactory  in  the  treatment  of 
this  disorder  is  the  psychrophore  of  Winternitz.  using  water  at  a 
temperature  of  60°  to  50°  F.  for  five  to  ten  minutes  daily.  Some 
writers  speak  favorably  of  the  rectal  irrigator,  the  bulb  of  which  is 
pressed  against  the  prostate,  employing  water  at  60°  to  503  F.  for 
five  to  ten  minutes.  Where  the  treatments  above  mentioned  cannot 
be  carried  out.  the  one  best  method  to  be  employed  in  the  home  is 
the  cold  sitz  bath  at  80°  F.  for  ten  to  fifteen  minutes,  reduced  three 
to  five  degrees  dailv  to  60°  or  50 3  F. 


542  PRACTICAL    HYDROTHERAPY. 

Priapism. 

Priapism  is  a  more  or  less  continuous  erection,  without  sexual 
desire.  Prolonged  mental  exertion,  over-anxiety,  diseases  of  the  brain 
and  cord,  neurotic  prostatic  disorders,  leucocythemia,  etc.,  produce 
the  disorder.  Mackie  thinks  a  small  extravasation  of  blood  in  the 
corpus  cavernosum  is  the  immediate  cause  of  the  priapism.  In  chil- 
dren a  tight  prepuce,  stone  in  the  bladder  or  worms  in  the  rectum 
may  cause  it.  In  its  management,  sedative  and  motor-depressant 
drugs,  in  connection  with  hydrotherapy,  will  bring  about  a  cure  save 
in  those  instances  where  organic  incurable  conditions  are  present. 

Causal  conditions  must  be  sought  for  and  hygienic  lines  in- 
stituted. The  diet  should  be  generous,  the  amount  of  meat  lim- 
ited; moderate  exercise  and  free  water-drinking  are  indicated.  The 
author  has  found  in  the  three  successful  cases  that  have  come  under 
his  care  that  the  following  general  tonic  treatment  and  local  measures 
have  been  most  satisfactory:  Commence  with  the  electric  light  bath 
to  free  perspiration,  followed  by  the  horizontal  rain  bath  at  104°  F. 
for  one  minute,  reduced  to  80°  F.  for  one-fourth  minute,  this  in  its 
turn  to  be  followed  by  the  neutral  sitz  bath  at  92°  to  94°  for  twenty 
to  thirty  minutes.  The  cold  water  of  the  rain  bath  should  be  gradually 
reduced  one  degree  daily  until  the  patient  can  stand  a  temperature 
of  65°  F.  When  this  point  has  been  reached  give  the  following: 
Electric  light  bath  to  free  perspiration,  followed  by  the  jet  douche 
to  the  dorso-lumbo-sacral  spine  and  thighs  as  hot  as  can  be  borne, 
115°  to  120°  F.  if  possible,  for  one  or  even  two  minutes,  this  to  be 
followed  by  the  neutral  sitz  bath  at  92°  F.  for  thirty  minutes.  In 
the  home,  or  where  institutional  treatment  cannot  be  obtained,  we 
may  use  the  same  general  measures  as  are  suggested  in  spermator- 
rhea, followed  by  the  half  bath  at  the  neutral  temperature  of  92° 
F.    for   thirty   minutes. 

Neuroses  and  Neuralgia. 

Nervous  and  neurotic  males  may  suffer  from  many  forms  of  nerve 
manifestations  of  the  generative  organs,  which  are  a  source  of  con- 
siderable anxiety,  worry,  mental  distress  and  physical  suffering.  It 
will  generally  be  observed  that  they  are  the  victims  of  some  of  the 
major  neuroses  or  psychoneuroses,  digestive  disorders,  gout,  rheuma- 
tism, lithemia,  etc.  These  general  conditions  require  that  particular 
treatment  which  has  been  heretofore  outlined  under  special  headings. 
In  the  local  management  of  such  cases  great  care  must  be  exercised 
to  seek  for  and  remove  any  sources  of  irritation  and  trouble  about 
the  genitals,  rectum  and  anus.  The  general  management  of  the  case 
is  very  much  more  important  than  the  local,  though  a  combination 
is   frequently  more  effective. 


GEXITO-URIXARY  DISEASES  AXD  SYPHILIS.        543 

These  cases  require  careful  examination  in  order  to  reach  a 
proper  diagnosis.  A  free  life  should  be  required,  moderate  out- 
door exercise  prescribed,  generous  dietary  given  and  tonics  ad- 
ministered. Nowhere  in  the  range  of  medical  practice  will  more  sat- 
isfactory results  be  obtained  than  in  the  use  of  hydrotherapy  in 
these  seemingly  intractable  and  disagreeable  conditions.  Most  cases 
are  in  fair  general  health,  and  are  best  treated  in  institutions,  and 
for  that  reason  we  may  at  once  commence  with  the  following  treat- 
ment: Electric  light  bath  to  free  perspiration  if  robust,  or  moderate 
perspiration  if  weak  and  anemic.  This  should  be  followed  by  the 
horizontal  rain  bath  at  100°  to  104°  F.  for  one  minute,  reduced  to 
80°  F.  for  one-fourth  minute,  twenty  pounds  pressure.  Reduce  the 
cold  water  two  degrees  to  60°  F.  and  increase  the  pressure  one  pound 
daily  until  thirty  is  registered.  As  soon  as  possible  the  jet  douche  is 
to  be  added  to  the  above  treatment  at  a  temperature  of  60°  F.,  applied 
up  and  down  the  spine  and  posterior  aspect  of  the  lower  limbs,  for 
one-fourth  minute,  pressure  thirty  pounds.  From  the  start  these 
treatments  should  be  followed  by  the  cold  sitz  bath  at  65°  F.  for 
three  to  five  minutes,  with  friction  applied  to  the  inner  surfaces  of 
the  thighs,  lower  abdomen  and  back. 

Where  pain  is  constantly  present  nothing  is  more  satisfactory  than 
the  use  at  bedtime  of  either  of  the  following  treatments :  Hot  trunk 
pack  from  the  epigastrium  to  the  middle  of  the  thighs  for  thirty  min- 
utes, followed  by  the  cold  sitz  bath  for  two  to  five  minutes  at  70°  to 
50°  F.,  or  the  hot  sitz  bath  at  105°  to  110°  F.  for  ten  to  fifteen  min- 
utes, finishing  the  treatment  with  an  affusion  to  hips  and  lower  ab- 
domen at  60°  to  50°  F. 

If  hyperesthesia  is  present,  the  neutral  temperatures  of  90°  to 
92°  F.  should  be  employed,  and  the  practitioner  may  take  his  choice 
of  the  neutral  full  bath,  neutral  half  bath  or  the  neutral  sitz  bath 
for  periods  ranging  from  twenty  to  sixty  minutes.  Where  the  pa- 
tient cannot  be  induced  to  carry  out  this  treatment,  the  application  at 
home  of  the  cold  sitz  bath  alone  at  a  temperature  of  60°  F.  for  ten 
minutes  will  oftentimes  work  wonders. 

Syphilis — Lues — Pox. 

Syphilis  is  a  chronic  infectious  disease  due  to  the  presence  and 
growth  in  the  human  body  of  a  specific  fixed  contagion,  possibly  the 
spirocheta  pallida.  It  originates  from  another  case,  has  its  incuba- 
tion, its  orderly  progression  of  symptoms,  constitutional  and  local  ; 
sequelas  occur  and  inoculation  protects  from  reinfection  except  in 
extremely  rare  cases.  Infection  may  occur  at  any  point  on  the  skin 
or  mucous  membranes.  Its  stage  of  incubation  is  ten  to  fifty  days, 
its  initial  lesion  a  chancre,  a  hard  brownish-red  nodule,  which  may 
erode  or  ulcerate.     This  is  followed  by  a  lymphangitis,  and  the  gen- 


544  PRACTICAL    HYDROTHERAPY. 

eral  overflow  or  development  in  the  system  of  the  poison,  followed 
by  a  secondary  stage,  accompanied  by  fever,  malaise,  anorexia,  head- 
ache, pains  in  the  limbs,  nervous  symptoms  and  general  eruptions 
upon  the  skin — macular,  papular  or  tubercular  in  character,  and  upon 
the  mucous  membranes  as  simple  inflammation,  mucous  patches,  moist 
papules  and  condylomata.  The  hair  falls  out  and  the  nails,  eyes, 
ears,  etc.,  may  be  affected.  The  lesions  are  inflammatory  in  character, 
and  subside  under  treatment.  This  stage  lasts  from  one  to  three 
years.  Periods  of  latency  occur  in  which  there  are  no  subjective  or 
objective  symptoms.  The  virus  is  transmissible  in  these  stages,  but 
not  in  the  next  or  tertiary,  which  is  marked  by  the  presence  of  deep- 
seated  inflammation  and  gummata.  These  occur  in  a  very  small  minor- 
ity of  cases.  Syphilis  is  becoming  attenuated ;  most  cases  are  benign. 
Treatment  mitigates  and  removes  its  phenomena,  may  prevent  their 
appearance,  and  hastens  its  cure.  But,  treated  or  untreated,  the  mal- 
ady ends  at  some  time,  though  its  exact  limits  have  never  been  settled. 
The  disease  may  be  inherited.  Uncleanly  habits,  epithelium  that  has 
been  macerated  or  eroded,  extreme  length  of  prepuce,  alcoholism 
( irritating  mucous  membranes ) ,  predispose.  Indiscriminate  sexual  con- 
gress is  the  most  frequent  direct  cause.  Many  cases  are  contracted  while 
under  the  influence  of  alcohol  because  of  sexual  exposure  with  indi- 
viduals that  at  other  times  would  be  abhorrent  were  the  individual 
in  his  or  her  normal  condition.  The  pathological  changes  found  are 
those  of  inflammation  and  inflammatory  deposits.  Evidence  seems 
to  point  strongly  to  the  curability  of  syphilis.  It  is  a  disease  essen- 
tially benign  so  far  as  danger  to  life  is  concerned,  and  average  lon- 
gevity is  not  seriously  diminished.  Syphilitics  who  have  followed  out 
their  courses  of  treatment  carefully  can  usually  with  safety  marry 
at  the  end  of  three  years,  provided  there  are  no  present  symptoms 
and  none  have  been  present  for  some  time.  In  proportion  to  syphilis, 
few  parasyphilitic  diseases  result.  Many  cases,  in  the  author's  opinion, 
would  not  result  had  the  patient  avoided  alcohol,  tobacco  and  other 
excesses.  The  depreciation  of  tissue  and  nutrition  that  results  from 
their  use  makes  them  the  most  baneful  of  predisposing  causes. 

The  author  believes  that  the  present  position  of  advanced 
thinkers  upon  the  treatment  of  syphilis  may  be  summed  up  in 
the  following  propositions :  That  the  disease  or  poison  is  not  to  be 
destroyed  but  slowly  and  certainly  combated  by  the  continuous  mod- 
erate "tonic"  use  of  mercury  just  short  of  its  physiological  effects; 
that  the  action  of  this  drug  is  to  remove  by  fatty  degeneration  the 
syphilitic  deposits  ;  it  is  not  to  be  used  in  large  antidotal  doses,  but 
as  an  eliminant,  and  that  the  better  the  general  health  the  less  in- 
fluence the  syphilitic  poison  will  have  upon  the  system.  As  a  natural 
corollary  to  these  propositions,  we  may  say  that  hydrotherapy  in 
combination    with   anti-syphilitic   medication    is   a   method    worthy   of 


GENITO-URINARY  DISEASES  AND  SY  I'll  I  LIS.        545 

more  attention  than  syphilogtaphers  have  as  yel  given  to  this  subject. 
The  combination  of  hydrotherapy  with  antisyphilitic  medication  en- 
ables us  to  use  much  smaller  doses  of  mercury  and  the  iodides,  and 
at  the  same  time  prevents  the  untoward  and  disagreeable  effects. 
The  author  has  seen  many  cases  who  were  unable  to  take,  assimilate 
and  utilize  specific  medication,  after  a  short  preliminary  hydriatic 
treatment,  receive  all  the  benefits  that  arise  from  the  specific  action 
of  these  medicines.  The  powerful  thermic  and  mechanical  action 
of  water  applied  to  the  cutaneous  surface,  together  with  the  stim- 
ulating influence  of  heating  procedures  now  used,  bring  about  rapid 
elimination  of  the  soluble  toxins  of  the  germ,  and  more  slowly,  but 
none  the  less  surely,  the  inflammatory  deposits  that  are  present  in 
the  tissues  of  the  patient.  These  facts  apply  to  mercury  no  matter 
whether  the  internal,  inunction  or  hypodermic  method  is  employed. 

The  patient  afflicted  with  this  infection  should  lead  a  quiet  life 
and  as  far  as  possible  an  uneventful  one,  taking  moderate  exercise  in 
the  open  air  and  avoiding  physical  strain.  The  diet  should  be 
nutritious  and  consist  largely  of  cereals,  vegetables,  fruits,  etc. 

The  author  was  much  impressed  in  reading  an  account  of  the 
treatment  of  this  disease  by  the  Sandwich  Islanders,  in  which  the 
individual  is  subjected  to  the  action  of  the  sun  while  covered  with 
a  thin  layer  of  sea  sand,  and  after  free  perspiration,  takes  a  cold 
plunge  in  the  surf.  The  results  obtained  were  excellent,  even  though 
no  drugs  were  used.  The  author  believes  that  in  the  incandescent 
electric  light  bath  the  physician  has  a  remedy  at  hand  that  is  nearly 
a  panacea  and  possesses  qualities  beyond  the  merely  spoliative  effects 
of  heat.  He  is  not  prepared  to  state  the  exact  modus  operandi  of  the 
electric  light  bath,  but  knows  it  to  be  a  clinical  fact  that  individuals 
who  have  resisted  treatment  over  long  periods  have  almost  immedi- 
ately begun  to  improve  where  the  electric  light  bath  was  instituted. 
The  following  method  has  given  the  author  so  much  satisfaction  that 
with  slight  variations  it  has  become  his  standard  method  of  treatment 
of  this  disease.  The  rules  and  regulations  that  are  to  govern  the 
patient  are  laid  dowrn,  tonic  doses  of  mercury  or  the  iodides,  or  both, 
are  given,  and  in  addition  the  following:  Electric  light  bath  to  point 
of  free  perspiration,  followed  by  the  half  bath  at  70°  F.  for  three 
minutes,  with  friction  applied  by  the  patient  and  attendant  to  the 
parts  immersed.  The  temperature  of  the  bath  is  reduced  one  degree 
daily  to  60°  F. ;  the  bath  is  finished  by  an  affusion  to  the  back  and 
chest  at  60°  F.  The  patient's  reactive  capacity  having  been  fully 
established,  we  may  proceed  to  the  following  measures :  The  electric 
light  bath  to  free  perspiration ;  horizontal  rain  bath  at  103°  to  105° 
F.  for  one  to  one  and  one-half  minutes,  reduced  to  80°  to  60°  F.  for 
one- fourth  minute,  pressure  thirty  pounds :  this  to  be  immediately 
followed  by  the  jet  douche  to  the  spine  and  the  fan  douche  to  the 


546  PRACTICAL    HYDROTHERAPY. 

body  at  60°  F.  for  ten  to  twenty  seconds,  pressure  thirty  pounds. 
Where  the  electric  light  bath  cannot  be  secured  the  vapor,  hot  air  or 
superheated  dry  hot  air  body  apparatus  may  be  substituted  and  good 
results  obtained,  but  the  electric  light  bath  is  the  undisputed  and 
leading  heating  method  in  this  disease.  When  the  disease  is  mitigated 
and  the  period  of  latency  occurs  it  is  an  excellent  plan  to  recommend 
to  our  patients  to  discontinue  all  medication  and  spend  from  three 
to  six  weeks  at  the  seashore  indulging  in  surf  bathing.  Where  this, 
the  treatment  par  excellence,  cannot  be  carried  out,  we  may  substitute 
in  the  home  the  use  of  the  hot-air  cabinet,  in  which  the  patient  should 
remain  until  free  perspiration,  or  the  full  hot  bath  at  102°  to  105°  F. 
as  a  preliminary  heating  measure.  Care  should  be  taken  in  both 
instances  to  keep  the  head  cool.  They  should  be  followed  by  the 
cold  sponge  at  80°  F.,  reducing  two  degrees  daily  to  60°  F.,  making 
the  sponge  or  towel  wetter  and  wetter  as  the  temperature  is  reduced. 
The  cold  shower  at  the  same  temperatures  or  the  cold  half  bath  and 
affusion  may  be  employed. 

Cachexia.' — The  syphilitic  poison  acting  upon  the  general  and 
nutritional  processes  of  the  body  sometimes  exerts  a  pernicious  retro- 
grade action  that  produces  a  tissue  starvation.  This  is  most  frequently 
accompanied  by  an  intense  anemia  and  a  failure  of  the  assimilative 
functions.  In  these  cases  we  frequently  have  also  to  deal  with  over- 
dosage of  mercurials  and  iodides.  Hydrotherapy  produces  almost 
immediate  results,  and  where  used  from  the  start,  avoids  and  prevents 
the  condition. 

Mercurialism. — The  excessive  use  of  mercury  may  produce  grave 
results  and  a  cachexia.  Its  excessive  use  is  marked  by  the  presence 
of  a  metallic  taste  in  the  mouth,  salivation,  gingivitis,  stomatitis,  a 
foul  oral  odor,  colicky  abdominal  pains,  diarrhea,  dysentery,  insomnia, 
erythema,  caries  of  the  teeth  and  sometimes  polyneuritis.  In  those, 
however,  who  are  cleanly  in  person,  who  take  the  trouble  to  keep  their 
teeth  and  mouth  clean,  whose  skin  is  active,  whose  circulation  is  good, 
will  avoid  the  untoward  effects  of  mercury.  Treatment  involves  the 
immediate  cessation  of  the  drug  and  the  full  eliminant  methods  men- 
tioned under  the  treatment  of  the  disease  itself. 

Suppression  of  Urine. 

In  this  condition  the  urinary  secretion  is  checked  and  no  fluid 
flows  from  the  kidney  through  the  ureters  to  the  bladder.  It  may 
originate  from  trauma,  fright,  emotions,  mental  distress,  from  cold, 
by  operations  on  the  bladder,  from  previous  chronic  nephritis,  etc. 
No  urine — or  very  little,  highly  colored — is  voided.  Suppression  is  a 
dangerous  symptom,  especially  if  long  continued.  Upon  catheterization 
the  bladder  is  empty.  Depression,  languor,  apprehension,  chill,  vom- 
iting and  headache,  with  possibility  of  coma,  are  its  accompaniments. 


GENITO-URINARY  DISEASES  AND  SYPHILIS.       547 

The  treatment  is  both  general  and  local.  A  close  of  some 
saline  cathartic  of  sufficient  size  to  actively  stimulate  the  bowel, 
together  with  the  ingestion  of  hot  drinks  containing  acetate  or 
bitartrate  of  potassium,  should  be  administered.  Give  a  hot  normal 
saline  enema,  followed  by  a  fomentation  at  130°  to  160°  F.,  applied 
over  both  kidneys  for  ten  minutes,  repeated  for  ten  minutes,  while 
at  the  same  time  the  ice-bag  is  applied  to  the  lower  third  of  the 
sternum.  In  severe  cases  the  use  of  hypodermoclysis  (500  to  1000  c.c. 
of  normal  saline  solution )  will  be  found  an  excellent  measure.  Gen- 
eral hot  applications  may  be  made.  The  full  warm  bath  at  102°  to 
105°  F.  for  five  to  ten  minutes,  followed  by  the  full  dry  pack  for 
thirty  minutes,  or  the  use  of  the  superheated  dry  hot  air  body  ap- 
paratus at  a  temperature  of  250°  to  350°  F.  for  twenty  to  sixty  min- 
utes, or  the  electric  light  bath,  full  strength,  to  point  of  free  per- 
spiration may  be  employed.  After  the  last  two  named  we  may  employ 
the  full  dry  pack  for  thirty  to  sixty  minutes.  In  chronic  cases  the 
neutral  bath  at  a  temperature  of  92°  to  94°  F.  for  twenty  to  sixty 
minutes,  or  the  Xauheim  or  effervescing  bath  at  90°  F.  for  ten  min- 
utes, will  be  found  excellent  methods,  as  they  stimulate  the  skin 
circulation  without  inducing  depressing  effects.  The  author  con- 
siders the  electric  light  bath  to  be  the  most  serviceable  method,  and 
far  superior  to  any  other  form  of  treatment  for  this  disorder,  the 
skin  being  excited  to  a  high  degree  of  activity,  at  the  same  time  that 
tonic   and    stimulating   effects   are   produced. 

Cystitis — Irritable  Bladder. 

Catarrh  of  the  bladder  is  an  inflammation  of  the  vesical  mucous 
membrane,  characterized  by  hypogastric  pain,  frequent  and  scanty 
micturition,  vesical  tenesmus,  rigors,  pyuria  and  some  fever.  It 
originates  from  some  irritative  or  pyogenic  infection.  The  chronic 
form  is  apt  to  run  a  tedious  and  long  course.  The  cystoscope  will  be 
found  useful  as  a  diagnostic  agent.  During  the  acute  stage  of 
the  disease  the  diet  should  be  largely  soft  or  liquid,  consisting  of  milk, 
eggs  and  broth.  The  patient  is  to  drink  freely  of  water,  especially 
Vichy  water  with  soda.  If  the  reaction  of  the  urine  is  found  to  be 
alkaline  we  may  administer  benzoic  acid;  if  ammoniacal,  salol. 
Salines  may  be  administered  to  the  point  of  free  catharsis.  The  in- 
tense pain  is  best  relieved  by  the  use  of  the  hot  enema,  and  the  irriga- 
tion of  the  vesical  viscus  with  a  hot  solution  of  permanganate  of 
potassium  (  1  :4000)  at  a  temperature  of  105°  to  110°  F.  This  should 
be  followed  by  the  application  of  very  hot  fomentations  over  the 
bladder  region.  In  the  chronic  form  use  a  liberal  diet,  for  the  most 
part  freed  of  meat.  The  free  drinking  of  alkaline  water  should  be 
continued  and  urotropin  administered  in  five  grain  doses  three  to  four 
times  daily.    The  bladder  should  be  irrigated  once — rarely  twice — daily 


548  PRACTICAL    HYDROTHERAPY. 

with  the  permanganate  solution,  1 :4000  or  1 :5000  strength,  gradually 
increased,  or  a  boric  acid  solution  used.  The  hot  sitz  bath  at  115°  to 
120°  F.  for  three  to  five  minutes,  followed  by  a  quick  affusion  of 
cold  water  to  the  hips,  will  probably  do  more  to  permanently  relieve 
the  vesical  irritation  than  almost  any  other  single  measure.  The  sitz 
bath  at  95°  F.  for  thirty  to  sixty  minutes  is  employed  by  some  hydri- 
atists,  but  the  writer  has  not  found  it  of  as  much  benefit  as  the 
treatment  just  outlined.  It  goes  without  saying  that  at  the  same 
time  the  general  health  of  the  patient  should  be  built  up  by  tonic 
hydrotherapeutic  measures,  and  such  causal  conditions  as  may  be  pro- 
ducing the  inflammation  treated  in  connection  with  the  vesical  disease. 

Hunner1  has  found  the  use  of  the  continuous  warm  (100°  F.) 
or  neutral  (94°  to  97°  F. )  bath  of  value  in  the  management  of 
chronic  and  intractable  cases  of  cystitis,  especially  in  women,  em- 
ploying continuous  irrigation  of  the  bladder  at  the  same  time.  The 
tubs  used  are  those  usually  employed  in  the  full  bath  treatment  of 
typhoid   fever. 

In  hospital  work  the  tub  is  filled  every  morning  to  the  desired 
depth  with  water  at  about  100°  F.,  taken  directly  from  the  city  supply 
pipes  by  means  of  a  hose.  To  keep  the  temperature  equable  after  the 
patient  has  been  for  some  hours  in  the  tub,  two  or  three  pails  of 
water  are  withdrawn  from  the  spigot  and  the  desired  quantity  of  hot 
water  is  poured  into  the  tub  from  above.  During  the  usual  day  of 
eight  hours  in  the  tub  this  changing  of  water  is  necessary  from  one 
to  three  times,  according  to  the  temperature  of  the  room.  If  one  were 
having  a  tub  made  especially  for  the  continuous  bath  treatment  it 
would  be  advisable  to  have  built  in  the  tub  at  one  end  a  small  recess 
under  which  could  be  placed  a  Bunsen  gas  burner  or  small  oil  lamp 
so  adjusted  as  to  keep  the  water  at  a  constant  temperature.  The 
patient  sits  or  lies  on  strips  of  canvas  which  stretch  across  the  tub 
and  are  held  in  position  by  brass  clips.  These  canvas  strips  are  about 
twenty-two  inches  wide,  and  may  be  folded  if  narrower  strips  become 
desirable.  The  strip  at  the  head  of  the  tub,  on  which  rest  the  pillows, 
is  stretched  as  tightly  as  possible  to  form  a  back  rest  if  the  patient  is 
sitting,  and  if  she  be  reclining  this  strip  is  slackened.  The  strip  at  the 
foot  may  be  separated  a  few  inches  from  the  middle  strip  on  which 
the  patient  sits,  in  order  that  she  may  easily  pass  her  feet  between 
them  to  the  floor  of  the  tub  and  thus  gain  a  rest  by  change  of  position. 
Light  slats  across  the  tub  are  covered  by  a  blanket  and  mackintosh, 
and  these  in  turn  by  a  white  sheet  or  spread.  This  covering  serves 
to  retain  the  heat,  makes  a  "work-table"  for  the  patient,  and  presents 
a  neat  appearance. 

If  a  continuous  irrigation  is  desired  a  gallon  bottle  rigged  with  a 

1   Hunner,    Guy    L. :    Journal    American    Medical    Association,    December   21,    1907,    "The 
Tub-Bath  Treatment  of  Cystitis." 


G1LXIT0-URINARY  DISEASES  AND  SY  I'll  I  LIS.        549 

siphon  rod  and  rubber  tubing  and  set  on  a  box  on  a  table  near  the 
tub  will  serve  as  a  supply  tank.  If  the  patient  is  not  excoriated  about 
the  genitalia,  and  particularly  if  she  has  little  or  no  bladder  pain, 
she  does  not  require  the  sitz  bath,  and  the  tub  may  be  used  without 
the  water.  The  patient  sits  on  the  dry  canvas  strips,  two  of  which 
are  so  separated  under  the  buttocks  as  to  allow  the  irrigation  to  run 
through  to  the  bottom  of  the  tub.  In  this  manner  a  constant  irriga- 
tion can  be  kept  flowing  with  no  other  attention  than  that  requisite 
for  the  supply  bottle  or  tank.  The  force  of  the  stream  entering  the 
bladder  is  regulated  by  the  height  of  the  supply  tank,  and  the  patient 
can  modify  the  stream  at  any  time  by  changing  the  calibre  of  the 
supply  tubing  through  the  use  of  an  artery  clamp  applied  to  the  side 
of  the  tube.  The  inflow  naturally  has  to  be  regulated  according  to 
the  sensitiveness  of  the  bladder,  and  to  suit  the  freedom  of  the  out- 
flow, whether  this  be  through  a  second  tube  in  the  urethra  or  through 
a  suprapubic  or  vaginal  fistula. 

These  miserable  and  obnoxious  cases,  both  to  themselves  and  all 
about  them,  are  made  comfortable  and  free  from  odor.  The  intense 
suffering  resulting  from  the  severe  inflammation  of  the  pudendal 
region  and  thighs,  the  insomnia,  nervousness,  anemia  and  digestive 
disturbances,  are  all  relieved.  To  the  nurse  it  saves  an  incalculable 
amount  of  labor,  and  the  wear  and  tear  upon  the  patient  of  changing 
of  pads,  gowns,  bedding,  etc.,  in  the  effort  to  preserve  cleanliness. 
It  is  "one  of  the  most  satisfactory  measures  in  the  realm  of  ther- 
apeutics." 

Atony  of  the  Bladder. 

Atony  of  the  urinary  viscus  is  manifested  by  a  lack  of  tone,  a  loss 
or  diminution  of  its  muscular  power.  After  forty  it  is  in  moderate 
degree  physiological,  being  characterized  by  an  inability  to  eject  a 
forcible  stream  of  urine  from  the  bladder.  It  may  be  a  true  muscular 
paresis,  a  flaccid  pouch  capable  of  distension  to  a  large  extent,  but 
incapable  of  completely  emptying  itself.  There  are  all  grades  and 
variations.  It  may  result  from  obstructive  conditions,  paralysis  of 
the  bladder,  persistent  neglect  of  Nature's  call  and  acute  over-dis- 
tension long  continued.  Residual  urine  is  usually  present,  requiring 
catheterization  and  irrigation. 

Where  the  conditions  are  non-surgical,  or  after  surgical  work, 
the  hydriatic  method  will  be  found  most  serviceable.  Great  care 
should  be  paid  to  the  general  health  of  the  patient,  removing  all 
sources  of  burden,  improving  the  appetite,  digestion,  assimilation  and 
elimination.  A  careful  diet,  free  water-drinking  and  urinary  anti- 
septics should  be  employed. 

Measures  that  may  be  daily  employed  in  the  home,  and  which  will 
be   found  very  efficacious,  are  the   following:     Commence  with  the 


550  PRACTICAL    HYDROTHERAPY. 

cold  sponge  to  the  waist  and  then  the  remainder  of  the  body,  starting 
at  80°  F.,  reducing  five  degrees  daily  until  60°  F.  is  reached.  This 
should  be  followed  by  a  good  vigorous  rub  with  a  crash  towel  until 
reaction  is  secured.  As  soon  as  60°  F.  is  reached  the  warm  full  bath 
at  102°  to  105°  F.  for  three  to  five  minutes,  followed  by  the  cold 
sponge  as  above  at  60°  F.,  may  be  employed.  The  next  step  should 
be  the  use  of  the  warm  full  bath,  followed  by  a  general  salt  rub  to 
the  entire  body,  terminating  the  treatment  with  a  cold  shower  at  60° 
F. ;  if  the  shower  cannot  be  obtained  it  may  be  followed  by  the  sponge 
at  the  same  temperature,  rapidly  performed,  or  by  an  affusion  at  the 
same  temperature  to  the  chest  and  back  while  sitting  in  about  six 
inches   of  warm   water. 

Institutional  or  sanatorium  measures  commence  with  the  incan- 
descent electric  light  bath,  hot  air,  vapor  or  superheated  dry  hot  air 
to  free  perspiration,  followed  by  the  rain  bath  at  102°  F.  for  one 
minute,  reduced  to  70°  F.  for  fifteen  seconds,  daily  reduced  two 
degrees  until  60°  F.  is  reached.  At  this  point  add  the  jet  douche  to 
the  spine  and  gently  over  the  hypogastric  region  at  60°  F.,  duration 
ten  to  fifteen  seconds.  If  the  patient  is  strong,  if  reaction  has  been 
well  developed,  we  may,  after  reaction  has  been  first  secured  from 
the  above  treatment  and  the  patient  dried,  employ  the  alternate  hot 
and  cold  perineal  douche  at  110°  to  115°  F.  for  a  half  to  three- 
quarters  of  a  minute,  cold  (60°  to  50°  F.)  for  fifteen  seconds,  two 
or  three  alternations. 

In  connection  with  home  or  institutional  treatment  nothing  will 
give  better  results  than  the  use  of  the  cold  sitz  bath  at  80°  F.  for 
eight  to  ten  minutes,  taking  care  to  keep  the  lower  limbs  warm  and 
slightly  elevated  to  prevent  pressure  of  the  popliteal  space.  Lower 
the  temperature  one  degree  daily  to  65°  or  even  60°  F.  This  bath 
will  drain  the  pelvis  and  tone  up  the  muscular  structure  of  the  viscus. 

Where  there  is  any  residual  urine  or  inflammation  present  the 
bladder  should  be  irrigated  or  douched  with  normal  saline  or  boric 
acid  solution,  commencing  with  a  temperaturee  of  100°  F.  and  re- 
ducing same  one  to  two  degrees  daily  until  as  cold  as  the  patient  can 
comfortably  stand.    It  is  a  powerful  stimulant  to  muscular  contraction. 

Enuresis;  Enuresis  Nocturna. 

Incontinence  of  urine,  usually  a  symptom  rather  than  a  disease, 
is  a  condition  characterized  by  the  involuntary  passage  of  this  ex- 
cretion. It  is  often  a  neurotic  manifestation,  especially  in  children, 
though  it  may  arise  from  muscular  weakness  of  the  bladder  neck,  over- 
distension, changes  in  the  composition  of  the  urine  and  spinal  cord 
disease.  The  prognosis  depends  on  the  cause.  In  enuresis  nocturna, 
it  is  favorable,  although  the  treatment  is  sometimes  prolonged.  General 
treatment  by  all  tonic  measures  is  the  most  essential,  and   for  this 


GENITO-URINARY  DISEASES  AND  SYPHILIS.       551 

reason  we  suggest  out-of-door  life  with  exercise  and  full  nutritious 
diet,  avoiding  meats  and  salts  at  supper.  Liquids  should  not  be  drunk 
during  the  late  afternoon  and  evening,  and  heavy  suppers  and  all 
forms  of  cerebral  excitement  in  the  evening  must  be  forbidden.  It 
is  most  essential  that  any  indigestion  or  constipation  present  be  cor- 
rected. We  may  commence  with  the  use  of  the  electric  light  bath  or 
the  hot  air  bath  until  perspiration  takes  place,  following  this  with 
the  dripping  sheet  at  70°  F.  for  three  minutes,  with  vigorous  friction. 
Reduce  temperature  one  degree  daily  until  60°  F.  is  reached.  This 
may  be  followed  by  the  cold  sitz  bath  at  60°  F.  for  three  to  five 
minutes.  In  the  writer's  hands  this  has  proven  the  best  treatment  for 
children,  supplemented  by  the  use  of  the  hot  and  cold  sponge  to  the 
spine  at  bedtime.  In  adults  we  may  use  the  electric  light  bath  or  the 
hot-air  bath  until  perspiration  takes  place,  following  this  with  the 
rain  bath  at  105°  F.  for  one  and  one-half  minutes,  reduced  to  70°  F. 
for  one-fourth  minute,  pressure  twenty  pounds.  Increase  pressure 
one  pound  daily  until  thirty  is  registered  and  reduce  temperature  one 
degree  daily  to  60°  F.  At  this  point  we  may  add  the  jet  douche  at 
60°  F.  for  one-fourth  minute  to  the  spine  and  the  fan  douche  at  60° 
F.  for  one-fourth  minute  over  the  abdomen  and  bladder  region. 
Immediately  following  the  reaction  from  this  bath,  administer  a  cold 
foot-bath  for  one-half  to  one  minute.  This  will  frequently  overcome 
the  condition.  Where  possible,  patients  may  supplement  their  con- 
valescence by  having  recourse  to  the  swimming  bath  or  surf  bathing. 
In  adults  hot  irrigation  of  the  viscus  daily  with  boric  acid  solution  at 
a  temperature  of  100°  F.,  gradually  reducing  one  degree  daily  until 
75°  or  80°  F.  is  reached,  will  very  frequently  aid  in  strengthening  the 
local  condition.  If  surgical  conditions,  such  as  phimosis,  exist,  they 
should  be  corrected.  In  connection  with  the  above  treatment  the 
author  has  frequently  found  the  preparations  of  iron  and  belladonna 
of  great  service. 

Retention  of  Urine. 

In  retention  of  urine  the  urinary  bladder  fills  up  and  the  urine  is 
not  or  cannot  be  passed.  Mechanical  obstruction  in  the  urethra  or 
prostate,  spasm  of  the  cut-off  muscle,  blunted  sensation  of  the  bladder 
in  certain  fever's,  in  some  brain  and  spinal  cord  diseases,  in  coma, 
shock,  etc.,  may  produce  the  condition.  In  retention  the  bladder  is 
dull  on  percussion,  in  suppression  tympanitic ;  pressure  causes  desire 
to  urinate. 

The  first  endeavor  should  be  to  catheterize  the  patient,  fol- 
lowed by  an  irrigation  of  hot  boric  acid  solution.  Sometimes 
the  retention  can  be  overcome,  if  it  is  spasmodic,  by  the  use  of  the 
hot  enema,  followed  by  the  sitz  bath  as  hot  as  can  be  borne.  Where 
the  disease  is  due  to  a  lack  of  muscular  power  of  this  viscus,  general 


552  PRACTICAL  HYDROTHERAPY. 

hydriatic  measures  will  build  up  the  general  health  and  increase  the 
muscular  tone  of  the  bladder.  It  will  be  found  serviceable  in  connec- 
tion with  the  application  of  the  cold  douche  to  the  bladder  region. 
Give  an  electric  light  bath  to  the  point  of  free  perspiration,  followed 
by  the  horizontal  rain  bath  at  102°  to  104°  F.  for  one  to  two  minutes, 
reduced  to  80°  F.  for  one- fourth  minute,  pressure  thirty  pounds; 
reduce  the  cold  water  two  degrees  daily  to  60°  F.  When  this  has  been 
reached  add  to  the  above  treatment  the  jet  douche  at  60°  F.,  pressure 
thirty  pounds,  applied  to  the  spine  and  posterior  aspect  of  the  limbs, 
finishing  the  treatment  by  a  strong  douche  to  the  feet  and  a  gentler 
one  over  the  bladder  region.  It  seems  needless  to  say  that  this  remedy 
should  be  withheld  in  a  case  of  retention  from  obstruction. 

Fissure  of  the  Anus  and  Irritable  Ulcer  of  the  Rectum; 
Sphincterismus. 

Primarily  these  conditions  commence  as  a  superficial  breach  of 
the  mucous  membrane  in  the  anal  region,  which,  if  unhealed,  finally 
results  in  the  formation  of  an  ulcer  of  the  bowel  which  may  involve 
the  mucous  and  submucous  coats,  giving  rise  to  a  spasmodic  contrac- 
tion of  the  parts  and  exquisite  paroxysmal  pain.  These  affections 
are  quite  common,  and  occur  more  frequently  in  women  than  in  men. 
It  may  result  from  constipation,  diarrhea,  dysentery,  surgical  opera- 
tions, trauma,  etc.  Fissure  and  ulcer  are  insignificant  in  size,  but 
give  rise  to  widespread  reflex  disturbances,  due  to  their  location, 
usually  at  the  muco-cutaneous  junction,  which  is  the  exit  of  the  ter- 
minal fibers  of  the  pudic  nerve,  the  filaments  being  numerous.  The 
pain  and  other  symptoms  occur  during  or  after  defecation.  General 
ill-health,  nervous  exhaustion  and  chronic  toxemia  may  and  often 
do  result  from  these  lesions.  Associated  frequently  with  the  condition 
is  sphincterismus,  a  spasm  of  the. sphincter  ani  muscle. 

Treatment  involves  regulation  of  any  existing  constipation  by 
means  of  a  vegetable  laxative,  preferably  cascara,  the  use  of 
normal  saline  enemata  and  a  non-irritating  diet ;  for  severe  cases 
rest  in  a  horizontal  position.  Palliative  measures  should  always  be 
first  tried,  consisting  of  suppositories  and  ointment  in  connection 
with  the  use  of  the  sitz  bath  at  75°  F.  for  fifteen  to  twenty  minutes. 
Where  the  patient  is  suffering  a  great  deal  of  pain,  apply  fomenta- 
tions to  the  perineum  and  nates  at  a  temperature  of  130°  to  160°  F. 
for  ten  to  fifteen  minutes,  followed  by  the  foot-bath  at  a  temperature 
as  hot  as  can  be  borne.  These  two  treatments  are  in  turn  to  be  fol- 
lowed by  the  application  of  the  ice-bag  to  the  anal  region.  In  several 
cases  the  author  has  seen  great  comfort  result  from  the  perineal 
douche  applied  to  the  perineum  and  anal  region  at  a  temperature 
of  110°  to  120°  F.  for  one  to  two  minutes.  Where  this  cannot  be 
obtained,  the  hot  sitz  bath  at  the  same  temperature  for  ten  to  fifteen 


DISEASES  OF  THE  RECTUM.  553 

minutes  will  oftentimes  prove  effective.  After  a  reasonable  length 
of  time,  should  these  methods  fail,  recourse  must  be  had  to  surgery. 
Immediately  after  the  sphincter  is  dilated  the  fomentation  should  be 
applied  ;    it  is  almost  a  specific  in  relieving  pain  and  soreness. 

Rectal  Prolapse. 

Prolapsus,  or  procidentia  recti,  is  a  protrusion  through  the  anus 
of  any  part  of  the  rectum,  either  mucous  membrane  or  one  or  more 
coats  of  the  bowel.  The  more  the  bowel  is  protruded  the  more  the 
parts  become  stretched  and  relaxed,  favoring  its  repetition.  Bloody 
oozing,  catarrhal  ulceration  and  inflammation  are  frequent  accom- 
paniments. At  first  present  only  with  stool  and  easily  reduced,  it 
may  occur  independent  of  fecal  action.  Where  extensive  it  involves 
the  peritoneum.  Straining  at  stool,  trauma,  difficult  urination  and 
violent  fits  of  coughing  have  been  the  causes  of  the  disease.  If  the 
mucous  membrane  alone  is  involved,  cure  is  often  effected.  It  should 
be  considered  usually  as  a  surgical  affection  ;  where  surgery  is  de- 
clined  treatment  becomes   palliative. 

All  causes  that  are  likely  to  have  produced  the  disease  should 
be  removed,  the  bowel  returned  to  its  proper  position,  if  neces- 
sary replacing  same  by  means  of  the  genu-pectoral  position.  The 
bowel  should  then  be  retained  in  position  by  a  compress  and 
properly  adjusted  bands.  The  bowels  are  regulated  by  cascara,  and 
defecation  accomplished  in  a  recumbent  posture.  An  abdominal  sup- 
porter will  be  found  of  considerable  service,  and  gives  a  great  deal  of 
relief  where  the  abdominal  walls  are  pendulous.  As  far  as  possible, 
tone  up  the  general  health  by  using  the  electric  light  bath  to  the  point 
of  free  perspiratoin,  followed  by  the  horizontal  rain  bath  at  102°  to 
104°  F.  for  one  to  two  minutes,  reduced  to  80°  F.  for  one- fourth 
minute,  pressure  thirty  pounds ;  reduce  the  temperature  of  cold  water 
two  degrees  daily  to  60°  F. 

Local  measures  will  be  found  valuable,  of  which  cold  water  ene- 
mata  or  ice-cones  covered  writh  iodoform  gauze  may  be  employed. 
The  best  local  measure  is  the  perineal  douche  applied  to  the  perineum 
and  anal  region  under  strong  pressure  at  a  temperature  of  60°  to  50° 
F.  for  one-half  to  two  minutes.  It  is  astounding,  sometimes,  what 
excellent  results  will  be  obtained  by  these  measures  alone.  In  some 
cases  where  the  prolapse  is  difficult  of  reduction,  the  patient  should 
be  placed  in  the  genu-pectoral  position  and  fomentations  at  130°  F. 
applied  for  five  to  ten  minutes,  followed  by  the  use  of  the  ice-cold 
compress.  This  method  will  usually  enable  the  physician  to  promptly 
bring  about  reduction. 

Hemorrhoids. 

Hemorrhoids  are  vascular  tumors  of  the  mucous  membrane  of 
the  rectum  or  anus,  or  both;    in  the  external  varietv  the  skin  alone 


554  PRACTICAL  HYDROTHERAPY. 

is  involved.  Internal  piles  of  long  standing  may  protrude  at  stool 
or  on  straining ;  may  return  spontaneously  or  have  to  be  replaced ; 
the  mucous  membrane  may  be  excoriated  or  ulcerated.  There  is 
usually  present  pain,  fullness,  heat,  tendency  to  strain,  and  pruritus. 
Hemorrhages  occur  from  ulceration,  etc.  Modern  civilization,  with 
its  strenuous  life,  lack  of  exercise,  carelessness  of  the  laws  of  Nature, 
constipation,  or  any  condition  that  will  prevent  the  return  of  blood 
from  the  hemorrhoidal  veins,  originates  the  disease.  Uterine  disease, 
the  gravid  uterus,  growths  of  the  liver,  cirrhosis,  enlarged  pros- 
tate obstructing  the  return  circulation,  alcoholism,  irregular  habits 
as  to  stool,  and  hereditary  disposition,  all  tend  to  their  formation. 

Immediately  regulate  the  diet,  eliminating  alcohol,  tobacco  and 
condiments ;  hygiene  must  be  established  and  moderate  exercise  pre- 
scribed. A  saline  cathartic  should  be  given,  and  when  catharsis 
has  been  produced  a  warm  normal  saline  enema  may  be  ad- 
ministered, followed  by  a  cold  one ;  should  the  hemorrhoids  be  in- 
flamed, the  fomentation  at  130°  to  150°  F.  for  ten  minutes,  or  the 
hot  sitz  at  110°  to  115°  F.  for  ten  to  fifteen  minutes,  followed  by  the 
application  of  a  compress  soaked  in  a  lead  and  opium  wash,  upon 
which  may  be  placed  an  ice-bag.  The  hot  foot-bath  will  oftentimes 
materially  aid.  In  a  chronic  case  we  should  employ  the  electric  light 
bath  to  the  point  of  free  perspiration,  followed  by  the  horizontal  rain 
bath  at  102°  to  104°  F.  for  one  to  two  minutes,  reduced  to  80°  F. 
for  one-fourth  minute,  pressure  thirty  pounds ;  reduce  temperature  two 
degrees  daily  to  60°  F.  Follow  this  treatment  with  the  cold  sitz  bath 
at  65°  to  55°  F.  for  five  to  ten  minutes,  or  the  perineal  douche  applied 
to  the  anal  region  at  60°  to  50°  F.,  under  as  strong  pressure  as  can  be 
borne,  for  one-half  to  two  minutes.  The  author  prefers  the  use  of 
the  electric  light  bath,  rain  bath  and  perineal  douche.  The  above 
treatment  is  purely  palliative,  permanent  results  being  obtained  by 
removal  through  operative  interference. 


CHAPTER  XXV. 
DISEASES  OF  THE  SKIN,  EYE  AND  EAR. 

Urticaria. 

Hives,  or  nettle-rash,  is  an  inflammation  of  the  skin  characterized 
by  wheals  of  a  whitish,  pinkish  or  reddish  color,  accompanied  by 
stinging,  prickly  sensations,  and  associated  with  gastro -intestinal  symp- 
oms.  It  is  a  cutaneous  irritation  due  to  some  indiscretion  in  diet, 
or  to  some  peculiar  effect  of  certain  substances,  such  as  fish,  crabs, 
lobsters,  strawberries,  etc.  It  arises  from  irritation,  from  hepatic, 
renal,  uterine  or  bladder  derangements,  neurotic  conditions,  pregnancy, 
lactation,  menopause,  etc.  It  is  an  acute  edematous  condition  of  the 
papillary  layer  of  the  skin,  characterized  by  the  development  of  wheals, 
which  consist  of  circumscribed  collections  of  semi-fluid  material,  the 
result  of  rapid  exudation  into  the  upper  layers  of  the  skin.  These 
wheals  may  appear  upon  any  portion  of  the  body,  their  size  varying 
from  a  pea  to  that  of  an  egg.  They  may  be  so  numerous  as  to  cover 
the  whole  body ;  their  size,  shape  and  color  vary.  Acute  attacks 
respond  readily  to  treatment,  but  recurrence  is  very  common. 

In  the  acute  stage  the  best  procedure  is  to  immediately  wash 
the  stomach,  leaving  therein  a  large  dose  of  Rochelle,  Epsom 
or  Crab  Orchard  salts.  This  should  be  supplemented  by  the  use 
of  a  hot  saline  enema  and  intestinal  antiseptics.  In  some  instances 
the  general  hot  bath  or  the  rain  bath  will  give  immediate  relief,  and 
in  others  it  will  be  necesary  to  use  the  cold  sponge  at  60°  to  50°  F., 
applying  cooling  compresses  especially  to  the  irritated  areas.  Some 
cases  are  much  benefited  by  a  very  hot  alkaline  sponge  at  a  tempera- 
ture of  130°  F.,  in  the  water  of  which  bicarbonate  of  soda,  a  drachm 
to  the  pint,  has  been  dissolved.  By  far  the  best  method  of  treating 
the  condition  is  the  use  of  the  neutral  bath  at  90°  to  92°  F.  for 
twenty  to  sixty  minutes.  This  bath  seems  to  have  the  property  of 
immediately  relieving  the  irritation  and  sedating  the  nervous  system. 
Every  endeavor  is  to  be  made  to  correct  the  patient's  method  of  living 
and  to  stimulate  the  excretory  and  eliminating  organs  to  the  utmost. 
This  is  best  accomplished  by  the  following  treatment :  Electric  light 
bath  to  free  perspiration,  followed  by  the  horizontal  rain  bath  at  104° 
to  105°  F.  for  one  minute,  reduced  to  65°  F.  for  one-fourth  minute, 
pressure  thirty  pounds,  immediately  followed  by  the  jet  douche  to  the 
spine  at  65°  F.,  pressure  thirty  pounds. 
(555) 


556  PRACTICAL  HYDROTHERAPY. 

Angioneurotic  edema  is  a  neurotic  condition  in  which  edematous 
circumscribed  swellings  appear  on  the  skin,  sometimes  on  the  mucous 
membranes,  which  disappear  after  a  variable  period  without  leaving 
behind  any  alteration  in  structure.  It  is  a  vasomotor  neurosis,  and 
oftentimes  arises  without  apparent  cause.  In  the  greater  number  of 
cases  seen  by  the  author  the  handling  of  ice  or  cold  objects  provoked 
an  attack.  Certain  drugs  are  said  to  produce  it.  Recurrences  are 
very  frequent,  and  when  the  larynx  is  involved  the  case  may  assume 
a  grave  aspect.  The  treatment  is  the  same  as  above  outlined  for  urti- 
caria. Especial  care  must  be  exercised  to  build  up  the  general  health 
and  train  the  vasomotor  mechanism  to  stand  cold  water.  When  this 
is  accomplished  the  area  of  sensitiveness  is  so  reduced  that  the  control 
of  the  disorder  is  usually  complete. 

Eczema. 

Eczema  is  a  non-contagious  inflammation  of  the  skin,  characterized 
by  any  or  all  the  results  of  inflammation.  These  results  may  occur  at 
once  or  in  succession,  as  erythema,  papules,  vesicles  or  pustules ;  may 
be  accompanied  by  more  or  less  inflammation  and  itching,  and  may 
terminate  in  serous  discharge  with  the  formation  of  crusts  or  in  des- 
quamation. It  may  be  acute,  subacute  or  chronic.  Eczema  attacks 
the  rich  and  poor,  the  infant  and  aged,  males  and  females.  Many 
families  are  especially  liable  to  its  development,  though  the  most  com- 
mon predisposing  causes  are  improper  food,  diseases  of  the  gastro- 
intestinal tract,  imperfect  elimination  of  waste  material,  deficient  uri- 
nary secretion,  Bright's  disease,  diabetes,  functional  and  organic  ner- 
vous affections,  rheumatic  and  gouty  diatheses,  contact  with  poison 
ivy,  heat  and  cold,  and  certain  chemical  and  mechanical  irritants.  Ec- 
zema is  a  dermatitis  with  serous  exudation.  There  is  first  hyperemia 
or  congestion  of  the  skin,  followed  by  serous  exudation.  It  is  the 
most  common  of  all  the  cutaneous  affections,  varying  in  accordance 
with  the  peculiar  location,  although  the  eruptions  present  all  the 
characteristics  of  an  inflammation,  namely,  redness,  heat,  swelling 
followed  by  a  discharge,  accompanied  by  itching  and  burning,  varying 
from  simple  annoyance  to  a  condition  almost  unendurable.  It  occurs 
most  frequently  on  the  face,  back  of  the  neck  and  genitalia.  When 
occurring  at  the  flexures  of  the  body  the  skin  is  liable  to  become  fis- 
sured, especially  in  those  regions  subjected  to  constant  motion. 

There  is  no  specific,  but  the  physician  must  search  carefully 
for  all  conditions  that  are  likely  to  produce  the  disease  or  un- 
dermine the  general  health.  The  diet  should  be  carefully  supervised, 
and  alcohol,  tea,  coffee,  candies,  pastries,  pickles,  starchy  foods  and 
condiments  positively  forbidden.  Fresh  air  and  moderate  exercise  are 
valuable ;  the  bowel  regulated  with  cascara ;  water  drunk  freely  and 
the  renal  secretions  stimulated.    General  hydrotherapy  will  be  valuable 


DISEASES  OE  THE  SKIN,  EYE  AND  EAR'.  557 

in  some  cases  in  order  to  overcome  the  extreme  toxemia  that  is  pres- 
ent. In  the  author's  experience  the  electric  light  bath  to  the  point 
of  moderate  perspiration,  followed  by  the  rain  bath  at  102°  to  104° 
F.  for  one  or  two  minutes  reduced  to  75°  F.  for  one-fourth  minute,  is 
the  best  method.  Where  there  are  many  scales  or  scabs  they  may  be 
removed  by  soap  and  water,  especially  if  they  are  chronic  in  character. 
When  the  lesions  upon  the  skin  have  healed  we  may  begin  decreasing 
the  temperature  of  the  cold  water  two  degrees  daily  until  60°  F.  is 
reached.  In  the  acute  stage  the  cooling  compress  or  the  cool  com- 
press covered  by  Leiter's  tubes  will  oftentimes  give  great  relief  to  the 
patient.  Hot-water  drinking  and  the  hot  normal  saline  enema  in 
toxic  cases  may  materially  aid  in  starting  the  patient  on  the  road  to 
recovery.  It  was  in  these  stubborn  cases,  and  especially  where  the 
irritation  and  itching  were  most  unendurable,  that  Hebra  obtained 
some  of  his  most  remarkable  results  by  instituting  the  use  of  Reiss' 
neutral  continuous  bath,  in  which  the  patient  remains  indefinitely  or 
during  waking  hours,  the  skin  being  anointed  once  daily  with  some 
lubricant. 

In  chronic  eczema  it  has  been  the  author's  experience  that  the 
better  the  general  health  and  elimination,  the  quicker  the  relief.  Com- 
mence with  the  electric  light  bath  to  free  perspiration,  followed  by  the 
horizontal  rain  bath  at  a  temperature  of  102°  to  104°  F.  for  one  to  two 
minutes,  pressure  twenty  pounds ;  reduce  the  temperature  two  de- 
grees to  60°  F.  and  increase  the  pressure  one  pound  daily  until  thirty 
is  registered.  As  soon  as  this  point  is  reached  institute  the  electric 
light  bath  to  free  perspiration,  followed  by  the  alternating  or  Scottish 
douche,  using  the  jet  and  fan  form  as  follows :  Jet  to  the  spine  and 
fan  to  the  body  at  105°  to  110°  F.  for  ten  seconds  each,  the  jet  to  the 
spine  and  fan  to  the  body  at  60°  F.  for  five  seconds  each,  pressure 
thirty  pounds ;  give  four  to  six  alternations.  Where  much  suffering  is 
present  the  local  use  of  the  fomentation  at  130°  F.  for  five  to  ten 
minutes  will  be  found  very  beneficial.  In  this  disease  the  hot  springs 
of  Arkansas,  Virginia,  Las  Vegas,  N.  M.,  Rockbridge  Alum 
Springs,  Va.,  and  Blue  Lick  Springs,  Ky.,  have  gained  quite  a  little 
reputation.  Chronic  cases  of  eczema  are  successfully  treated  by 
means  of  the  neutral  continuous  bath  at  Leukebad,  Switzerland.  Surf 
bathing,  with  the  salines  and  mechanical  friction,  is  valuable,  both  as 
a  general  and  local  measure.  The  water  is  a  parasiticide  of  marked 
value. 

Pemphigus. 

Pemphigus  is  an  inflammatory  disease  of  the  skin,  either  acute 
or  chronic,  and  characterized  by  the  development  of  a  succession  of 
round,  irregularly-shaped  blebs,  varying  in  size.  It  usually  originates 
from    nervous    prostration,    general    debility,    disorders   of   menstrua- 


558  PRACTICAL  HYDROTHERAPY. 

tion,  etc.  It  is  much  more  frequent  in  the  female  sex,  is  sometimes 
hereditary,  though  in  nearly  all  cases  its  origin  is  unknown.  It  is 
generally  considered  to  be  a  trophoneurosis,  the  blebs  being  situated 
on  the  epidermis  and  arising  from  sudden  effusion  from  the  vessels 
of  the  corium.  The  contents  of  the  blebs  consist  of  yellowish  serum 
of  a  neutral  or  alkaline  reaction,  that  may  after  a  while  become  puri- 
form.  The  disease  is  a  rare  one,  and  the  outlook  uncertain.  Most 
cases  pursue  a  lingering,  chronic  course.  Two  cases  in  the  author's 
practice  recovered  and  have  remained  well  for  periods  of  six  and 
eight  years  respectively. 

The  most  important  element  is  the  reconstruction  of  the  gen- 
eral health  and  restoration  of  the  nervous  system.  This  can 
best  be  accomplished  by  the  combination  of  rest,  tonics,  nutritious 
food  and  hydrotherapy.  As  long  as  the  blebs  are  present  we  should 
employ  the  neutral  bath  at  90°  to  92°  F.  for  twenty  to  sixty  minutes 
once  or  twice  daily.  Hebra  advises  the  continuous  bath  night  and 
day  until  healing  has  taken  place.  The  author  has  found  in  his  very 
limited  experience  that  as  soon  as  the  blebs  disappear  benefit  will 
be  obtained  from  the  use  of  tonic  hydrotherapy,  provided  the  cutane- 
ous stimulation  is  very  mild.  I  have  employed  in  these  cases  the  elec- 
tric light  bath  to  point  of  perspiration,  followed  by  the  rain  bath  at 
100°  F.  for  one  minute,  reduced  to  80°  F.  for  one-fourth  minute, 
and  gradually  reduced  one  degree  daily  to  70°  F.,  below  which  it 
should  rarely  go.  The  pressure  that  is  best  maintained  is  ten  to  fif- 
teen pounds. 

Herpes  Simplex. 

Herpes,  or  "fever  blisters,"  is  an  acute  inflammation  of  the  skin, 
characterized  by  the  development  of  one  or  more  clusters  of  vesicles, 
filled  with  a  clear  serum  and  occurring  for  the  most  part  upon  the 
face  and  genitalia.  It  is  present  most  frequently  during  fevers,  gastro- 
intestinal and  nervous  disorders.  It  may  occur  from  friction  and 
uncleanliness.  The  affection  is  usually  neurotic  in  origin.  Some 
authors  believe  it  to  be  a  toxic  neuritis  of  a  cutaneous  nerve.  The 
eruption  is  usually  in  the  form  of  a  cluster  of  vesicles  containing  a 
clear  fluid,  which  dries  up  and  forms  brownish  crusts,  finally  disap- 
pearing without  leaving  a  scar.  The  most  frequent  places  are  the 
lips,  aire  of  the  nose,  mucous  membrane  of  the  mouth,  the  tongue 
and  prepuce. 

Many  cases  require  no  treatment  at  all,  but  where  the  condi- 
tion is  troublesome  and  frequent  we  should,  as  far  as  possible,  remove 
the  cause,  institute  cleanliness  and  build  up  the  general  health.  This 
can  be  best  accomplished  by  the  use  of  the  electric  light  bath,  hol-air 
bath  or  the  superheated  dry  hot-air  body  apparatus,  to  free  perspira- 
tion, followed  by  the  horizontal  rain  bath  at  1C0°  to  102°  F.  for  one  to 


DISEASES  OE  THE  SKIN,  EVE.  .1X1)  EAR.  559 

two  minutes,  reduced  to  65°  F.  for  one-fourth  minute,  pressure  twenty- 
five  to  thirty  pounds,  followed  hy  the  jet  douche  to  the  Spine  and  the 
fan  douche  to  the  epigastrium  for  ten  seconds  at  a  temperature  of 
65°  1\  The  home  methods  mentioned  may  be  employed  where  access 
to  institutions  is  impossible. 

Herpes  Zoster. 

Shingles  is  an  acute  inflammatory  disease,  characterized  by  the 
development  of  firm,  distended  vesicles,  situated  upon  inflamed  bases 
corresponding  to  nerve  distribution,  and  accompanied  by  more  or 
less  severe  neuralgic-like  pains.  The  eruption  is  the  immediate  result 
of  the  inflammation  of  the  ganglia  or  the  nerve  trunks  and  branches 
of  the  trophic  fibers  of  the  affected  area.  Its  origin  is  obscure;  cold, 
injury,  anemia  and  exposure  have  been  assigned  as  the  causes.  The 
affection  is  characterized  by  neuralgic  pains,  followed  by  the  appear- 
ance of  papules  and  vesicles  in  the  area  of  pain,  situated  on  bright  red, 
highly  inflamed  bases.  They  are  about  the  size  of  pin-heads,  usually 
discrete,  greatly  distended,  and  disappear  at  the  end  of  the  second 
week.  The  vesicles  are  well  shaped  and  distended  with  a  translucent, 
yellowish  fluid.  Recurrence  is  rare,  and  the  case  usually  terminates 
in  recovery. 

In    the    early    stage    pain    is    best    combated    by    the  fomentation 

or    hot    compress    at    130°    to    160°    F.,    followed,    as    suggested    by 

Kellogg,    by    the    neutral    compress    at    90°    to  92°    F.,    so    applied 

as  to  exclude  the  air.     Upon  recovery  general  tonic  measures  should 

be  instituted. 

Acne. 

Acnc-vulgaris  is  an  inflammation,  usually  chronic,  of  the  sebaceous 
glands  of  the  skin,  and  characterized  by  the  development  of  papules 
or  pustules  or  the  combination  of  such  lesions,  occurring  for  the  most 
part  on  the  face.  The  causes  of  acne  are  not,  as  a  rule,  well  under- 
stood, but  it  occurs  most  frequently  at  puberty,  especially  where  men- 
strual disturbances  are  present.  Digestive  disorders,  constipation, 
anemia,  chlorosis,  sedentary  lives,  general  debility  and  lack  of  muscu- 
lar tone  are  all  assigned  as  provocative  agents.  It  may  appear  alone 
or  be  associated  with  comedo  or  seborrhea.  It  is  an  inflammation  of 
the  structures  of  the  sebaceous  glands  and  their  surrounding  tissue. 
The  sebaceous  secretions  are  first  retained,  as  a  result  of  which  hyper- 
emia and  exudation  into  the  gland  wall  and  about  the  gland  take  place, 
with  inflammation  of  the  connective  tissue  followed  by  suppuration, 
which,  if  severe  enough,  destroys  the  gland,  with  a  resulting  cicatrix. 
The  inflammation  is  usually  of  short  duration,  soon  followed  by  pus, 
presenting  the  characteristic  pin-head  or  pea-sized  pointed  papule, 
situated  about  the  sebaceous  follicles,  with  a  minute  central  black 
point,  the  opening  of  the  sebaceous  duct.     The  lesions  are  unaccom- 


560  PRACTICAL  HYDROTHERAPY. 

panied  with  either  local  or  constitutional  symptoms.  The  forehead  is 
the  most  common  location.  The  disease  is  essentially  chronic,  and  may 
last   for  years. 

The  most  important  element  in  the  permanent  relief  of  acne 
is  building  up  the  general  health,  and  this  is  most  rapidly  ac- 
complished by  careful  attention  to  the  correction  of  digestive  dis- 
turbances, constipation,  and  thorough  elimination  by  the  kidney.  The 
diet  should  be  restricted  in  that  an  excess  of  sugar,  pastries  and  meats 
must  be  forbidden.  Some  cases  cannot  touch  fried  foods  or  greasy 
pork.  Alcohol,  tobacco,  tea  and  coffee  are  best  avoided,  or  the  last 
two  used  with  extreme  moderation ;  exercise  in  the  open  air  and  ab- 
dominal massage  are  valuable ;  tonics  should  be  prescribed.  In  the 
general  reconstruction  nothing  equals  hydrotherapy,  as  it  relieves 
gastro-intestinal  disturbances,  increases  the  muscular  tone,  builds  up 
nervous  energy  and  favors  elimination.  It  should  be  both  general  and 
local.  Commence  with  the  electric  light  bath,  hot-air  bath  or  super- 
heated dry  hot-air  body  apparatus,  the  first  two  to  the  point  of  pro- 
fuse perspiration,  and  the  last  for  thirty  to  sixty  minutes,  followed 
by  the  horizontal  rain  bath  at  102"  to  104°  F.  for  one  to  two  minutes, 
reduced  to  80°  F.  for  one-fourth  minute,  pressure  twenty-five  to 
thirty  pounds;  reduce  the  cold  water  two  degrees  daily  to  60°  F.,  at 
which  time  add  to  the  above  treatment  the  jet  douche  to  the  spine  for 
ten  seconds  and  the  fan  douche  to  the  body,  especially  the  epigas- 
trium, for  ten  seconds  at  60°  F.  This  treatment  is  the  most  effective 
that  can  be  administerd.  but  where  it  cannot  be  carried  out  use  the 
following:  The  full  warm  bath  at  100°  to  104°  F.,  with  friction 
applied  by  means  of  the  flesh  brush,  for  five  to  six  minutes,  this  in  its 
turn  to  be  followed  by  the  rapid  cold  sponge,  commencing  at  80°  F., 
and  reduced  five  degrees  daily  to  60°.  making  the  sponge  or  towel 
wetter  and  wetter  each  application.  Where  it  can  be  obtained,  the 
hot  bath  above  described  should  be  given,  followed  by  the  shower 
at   -ame  temperature  as  the  sponge. 

The  local  treatment  of  acne  has  for  its  aim  stimulation  of  the  seba- 
ceous follicles  of  the  face  and  the  prevention  of  the  closure  of  the 
duct.  Those  that  are  already  closed  should  be  opened,  their  contents 
expressed,  or,  where  forming,  expressed  without  puncture.  As  soon 
as  this  has  been  completed,  green  soap  (  saponis  viridis  )  must  be  rubbed 
well  into  the  skin  and  allowed  to  remain  thereon  for  ten  to  fifteen 
minutes — some  authors  recommend  all  night — to  be  followed  by  the 
fomentation  as  hot  as  can  be  borne.  The  best  time  to  make  this  appli- 
cation is  bed-time,  but  should  the  green  soap  be  allowed  to  remain 
upon  the  face  all  night  the  hot  fomentation  must  be  applied  the  next 
morning:  it  must  be  followed  with  cold  water  or  the  cold  compress 
at  50"  to  60"  F.  for  one-half  to  one  minute  in  order  to  prevent  chap- 
ping or  coryza.     Surf  bathing  often  cures  the  case. 


DISEASES  OF  THE  SKIN,  EVE  AND  E.IK.  561 

Psoriasis. 

Psoriasis  is  a  chronic  affection  of  the  >kin,  characterized  by  reddish, 
more  or  less  thick,  elevated,  dry,  inflammatory,  wrinkled  patches,  vari- 
able as  to  size,  shape  and  number,  and  covered  with  whitish  or  grayish- 
colored  scales.  Its  origin  is  unknown,  but  heredity,  gout,  rheumatism 
and  some  infectious  diseases  are  supposed  to  cause  it.  It  occurs  in  the 
robust  and  in  the  feeble,  in  both  males  and  females,  and  is  non-con- 
tagious. The  disease  is  essentially  a  hyperplasia  of  the  normal  con- 
stituents of  the  Malpighian  layer.  It  usually  begins  with  reddish  spots 
of  the  size  of  a  pin-head,  which  become  covered  with  scanty  or 
abundant  white  or  grayish  scales.  The  spots  gradually  increase  in 
diameter  by  peripheral  extension,  forming  patches  of  various  sizes 
and  shapes.  The  skin  between  the  patches  is  perfectly  healthy.  Any 
portion  of  the  body  is  liable  to  be  affected,  but  the  elbows,  knees  and 
scalp  are  most  frequently  involved.  The  greatest  discomfort  ex- 
perienced by  the  patient  is  an  itching,  which  at  times  may  be  severe 
and  distressing.  The  disease  is  essentially  chronic ;  few  cases  are 
permanently  cured,  but  improvement  may  take  place  for  months  at 
a  time. 

Improvement  of  the  general  health  offers  the  best  outlook, 
and  to  that  end  the  correction  of  any  constitutional  tendency, 
the  relief  of  digestive  disturbances,  regulation  of  diet  and  prevention 
of  constipation  may  be  expected  to  bring  about  beneficial  results. 
Arsenic  is  valuable.  The  best  result  that  the  author  has  obtained  in 
the  treatment  of  this  disease  has  been  by  the  following  method:  The 
patient  at  the  start  is  given  the  electric  light  bath  to  the  point  of  free 
perspiration,  followed  by  the  neutral  bath  at  92°  to  94°  F.  for  twenty 
to  forty  minutes.  The  patient  is  gently  dried  and  care  taken  to  prevent 
coryza.  As  the  patient  improves  cold  applications  are  cautiously  made, 
commencing  with  the  cold  sponge  at  90°  F.,  reducing  one  degree  daily 
to  75°  F.,  gradually  making  the  sponge  or  towel  wetter  and  wetter. 
At  this  point  substitute  the  dripping  sheet  at  75°  F.  for  three  minutes, 
with  vigorous  friction,  and  reduce  the  temperature  one  degree  daily 
to  65°  F.,  at  which  time  give  the  horizontal  rain  bath  at  100°  F.  for 
one  minute,  reduced  to  65°  F.  for  one-fourth  minute.  YVe  may  now 
have  recourse  to  the  alternate  or  Scottish  douche  at  a  temperature  of 
100°  to  104°  F.  for  the  hot  and  60°  F.  for  the  cold,  four  to  six  alterna- 
tions. The  Scottish  douche  should  be  applied  in  the  form  of  a  jet  to 
the  spine  and  lower  limbs  and  as  a  fan  douche  to  the  body. 

Hebra  and  other  skin  specialists  have  recommended  the  continuous 
neutral  bath,  claiming  excellent  results,  and  for  this  reason,  and  be- 
cause of  other  advantages,  send  their  patients  to  Luekebad  in  Switzer- 
land. The  author's  experience  has  been  that  while  relapses  occur 
where  a  thorough  course  of  hydrotherapy  is  taken,  the  well  interval 


562  PRACTICAL  HYDROTHERAPY. 

is   longer.      Sea  bathing   should   be   tried,  not  less  than    four   to   six 
weeks'  course. 

Dermatitis. 

Dermatitis  is  an  inflammation  of  the  skin,  the  result  of  local  irrita- 
tion, and  presents  the  usual  phenomena  of  redness,  heat,  pain,  swelling, 
tenderness  and  loss  of  function.  Extreme  cold  (frost-bite),  extreme 
heat  (burns)  and  the  solar  rays  (sunburn)  are  forms  of  dermatitis, 
and  vary  in  many  grades  of  severity  from  erythema  and  vesication  to 
gangrene.  Dermatitis  may  arise  from  poisonous  plants,  chemical 
irritants,  from  the  handling  of  certain  articles  by  individuals  engaged 
in  trades,  from  X-ray  exposure,  from  drugs,  from  food  and  many 
other  causes.  The  earliest  manifestations  are  redness  and  a  slight 
swelling,  which  may  subside  at  this  point,  but  if  the  irritant  is  con- 
tinued the  swelling  becomes  more  intense,  vesicles  or  blebs  form  on 
the  affected  region,  accompanied  by  intense  pain  and  itching.  In  a 
moderate  degree  the  irritation  usually  subsides  spontaneously,  but  may 
be  prolonged  by  continued  exposure. 

Eurns. 

A  burn  is  a  severe  grade  of  dermatitis  resulting  from  the  direct 
or  indirect  application  of  dry  or  moist  heat  to  a  portion  of  the  cutane- 
ous or  mucous  surface.  Burns  may  be  superficial  (first  degree), 
involve  the  entire  epidermis  and  part  of  the  true  skin  (second  degree), 
or  the  deeper  structures  (third  degree).  Electricity  and  the  X-rays 
produce  severe  and  devitalizing  burns.  Shock  varies,  sometimes  slight, 
sometimes  alarming.  The  involvement  of  one-fourth  to  one-third  of 
the  body  may  result  in  death.  Early  mortality  is  due  to  shock ;  later, 
to  infection  from  suppuration.  Many  complications  may  set  in,  of 
which  meningitis,  tetanus,  bronchitis,  pneumonia,  inflammation  of  the 
gastro-intestinal  mucosa,  with  the  formation  of  ulcers,  have  been 
frequently  observed.     Deformities  frequently  result  from  scars. 

In  dermatitis  the  most  satisfactory  hydriatic  application  is 
the  cold  compress  at  50°  to  70°  F.,  replaced  every  ten,  fifteen 
to  thirty  minutes,  or  as  often  as  it  may  become  warm.  The  idea  of 
this  application  is  to  repeat  it  frequently  enough  to  prevent  reaction 
and  the  secondary  dilatation  that  follows.  Where  it  is  repeated  suffi- 
ciently often  it  causes  the  constriction  of  surface  blood-vessels,  lowers 
the  temperature,  destroys  sensation,  abolishes  reflex  irritation  and  ex- 
cludes the  air.  This  treatment  will  be  all  that  is  necessary  in  the  mild 
cases  of  dermatitis,  severer  conditions  being  met  in  the  manner  out- 
lined for  burns. 

Burns  are  serious,  especially  if  any  great  extent  of  surface  is 
involved,  and  the  aim  should  be  to  immediately  check  the  inflammation, 
prevent  sepsis,  assist  normal  elimination  of  eschar,  the  development 
of  granulations  and  limitation  of  deformity.     Here,  again,  the  cool 


DISEASES  OF  THE  SKIN,  EYE  AND  EAR.  563 

compress  at  70°  to  50°  F.,  changed  every  ten  to  thirty  minutes,  or 
as  often  as  warm,  or  the  use  of  the  compress  and  Leiter's  tubes  with 
water  circulating  at  the  same  temperature,  serve  a  useful  purpose. 
Kellogg  has  suggested  a  similar  method,  called  by  him  the  "irrigation 
compress,"  which  is  nothing  more  or  less  than  a  compress  upon  which 
the  water  from  70°  to  50°  F.  is  allowed  to  constantly  drip  from  a 
receptacle  placed  above  the  level  of  the  part  covered  by  the  compress, 
the  superfluous  water  being  drained  into  a  bucket  by  means  of  a  rubber 
sheet  placed  under  the  part.  Where  the  burns  are  very  extensive  and 
life  is  endangered,  great  care  must  be  taken  to  keep  the  bowels  open 
and  the  kidneys  active.  In  this  case  hypodermoclysis  at  fairly  frequent 
intervals  is  excellent,  as  it  dilutes  the  toxins,  prevents  their  absorption 
and  favors  elimination.  Nothing  approaches  the  use  of  the  continuous 
neutral  bath,  either  local  or  general,  a  method  highly  praised  by  Reiss 
and  used  with  great  frequency  by  Hebra. 

The  author  shall  never  forget  the  impression  made  upon  him  in  his 
observations  in  Vienna  of  the  treatment  of  extensive  burns  by  this 
method.  For  these  cases  Luekebad  likewise  has  a  high  reputation, 
and  it  is  certainly  to  be  regretted  that  in  this  country  the  treatment 
is  not  more  frequently  employed,  for  it  relieves  pain  and  suffering, 
prevents  absorption  of  a  large  amount  of  poison,  keeps  the  surface 
clean,  is  as  nearly  aseptic  as  possible,  stimulates  renal  activity  and 
elimination.  It  is  the  ideal  method  of  treatment.  These  cases  should 
have  applied  to  the  uninjured  skin  surface,  once  daily,  a  coating  of 
vaseline  or  some  other  unguent. 

Furuncle. 

A  boil  is  an  acute  affection  of  the  skin,  characterized  by  the  occur- 
rence of  one  or  more  circumscribed  cutaneous  or  subcutaneous  ab- 
scesses, which  are  usually  terminated  by  necrosis  of  the  central  tissue, 
with  subsequent  evacuation  in  form  of  pus  or  a  "core,"  and  followed 
by  the  formation  of  a  cicatrix.  Boils  usually  result  from  inflammation 
of  the  hair  follicles  from  infection  by  micro-organisms,  though  their 
occurrence  is  often  associated  with  general  debility,  anemia,  diabetes, 
uremia,  uncleanliness,  etc.  A  boil  frequently  commences  in  a  sebace- 
ous gland  as  a  small,  round  spot,  which  gradually  increases  in  size 
until  a  certain  dimension  is  attained.  When  suppuration  begins  a 
core  results,  composed  of  the  gland  in  which  it  originally  started  and 
the  pus  that  has  formed  around  it.  This  core,  when  thrown  off,  is 
composed  of  a  whitish,  tough  mass  of  dead  tissue,  varying  in  size 
with  the  extent  and  depth  of  the  inflammation.  The  staphylococcus 
pyogenes  aureus  is  usually  present.  The  abscess,  as  a  rule,  is  small, 
round,  highly  inflamed  and  tender  to  pressure,  with  evidence  of  sup- 
puration. Constitutional  symptoms  may  be  present  according  to  the 
size  of  the  lesion.     Any  portion   of  the  body  may  be  attacked,  but 


564  PRACTICAL  HYDROTHERAPY. 

preference,  however,  is  shown  for  the  face,  neck,  back,  axilla,  nipples, 
etc.     Boils  may  impair  the  general  health  greatly. 

In  the  very  early  stage  of  the  formation  of  the  boil  we  may 
possibly  be  able  to  relieve  the  pain  and  abort  its  formation  by 
stimulation  of  vital  action.  This  can  best  be  accomplished  by  the 
repeated  application  of  the  fomentation  at  130°  to  160°  F.  In  the 
later  stages,  when  suppuration  has  commenced,  the  fomentation  will 
*be  found  valuable  in  that- it  hastens  pus  formation  and  enables  the 
core  to  be  thrown  off  more  easily.  It  should  be  here  noted  that  when 
suppuration  is  present  the  fomentation  should  be  applied  for  short 
periods  of  time  only.  Never  use  poultices,  as  they  are  uncleanly, 
sticky  and  inefficient  in  retaining  heat.  The  fomentation  is  cleanly 
and  antiseptic.  As  soon  as  pus  forms  the  author  believes  that  an 
incision  should  be  made,  followed  by  the  use  of  the  fomentation. 

Carbuncle. 

A  carbuncle  is  an  indurated,  more  or  less  circumscribed,  dark  red, 
painful,  deep-seated  inflammation  of  the  skin  and  the  subcutaneous 
connective  tissue,  terminating  in  a  slough  and  the  subsequent  pro- 
duction of  a  permanent  cicatrix.  It  occurs  usually  in  middle-aged 
individuals  and  in  men  more  frequently  than  in  women.  General 
ill-health,  diabetes  and  local  trauma  predispose  to  the  invasion  of  the 
micro-organism.  The  affection  is  usually  manifested  by  a  single 
lesion,  which  occurs  with  great  frequency  on  the  back  of  the  neck, 
shoulders  or  between  the  scapulae.  It  begins  in  the  lower  layers  of 
the  integument,  first  resembling  a  phlegmon,  but  is  devoid  of  its  red 
color.  The  area  soon  becomes  a  hard,  circular,  flat  body  raised  above 
the  surrounding  parts,  with  painful  infiltration  of  the  skin  and  sub- 
cutaneous connective  tissue,  the  size  varying  from  a  hazelnut  to  that 
of  an  orange;  the  color  is  violacious,  and  after  a  week  or  ten  days  the 
pressure  results  in  sloughing  at  numerous  points,  from  which  dead 
masses  of  tissue  and  pus  are  discharged.  This  gives  the  lesion  its 
characteristic  cribriform  appearance.  The  final  slough  leaves  a  large, 
deep,  open  ulcer,  with  firm  everted  edges  that  granulate  slowly  and 
leave  a  permanent  cicatrix.  The  prognosis  is  fairly  grave  if  the 
patient  is  debilitated ;  general  infection  should  always  be  borne  in 
mind. 

Carbuncle  requires  attention  to  all  those  measures  that  will 
build  up  the  general  health.  Nutritious  diet  that  is  easily  digested, 
regulation  of  the  cloaca,  rest  and  the  internal  administration  of 
the  tincture  of  the  chloride  of  iron,  together  with  quinine,  arsenic 
and  strychnia.  The  positive  action  of  superheated  dry  hot  air  in  this 
and  the  preceding  affection  is  brought  about  by  its  destructive  action 
upon  the  micro-organisms  present,  through  the  active  hyperemia  and 
leucocytosis  induced,  followed  by  a  rise  in  the  opsonic  index ;  second- 


DISEASES  OE  THE  SKIN,  EYE  AND  EAR.  565 

arily,  the  skin  is  sterilized.  My  experience  has  been  that  local  rein- 
fection never  occurred,  that  the  general  septic  tendency  was  removed, 
while  the  pain  was  almost  immediate!)-  assuaged  by  the  sedative  action 
of  the  heat  and  the  relief  in  the  tension  of  the  infiltrated  area. 

In  the  very  early  stage  of  carbuncle  the  fomentation  at  130° 
to  160°  I\,  repeatedly  applied,  will,  as  in  the  case  of  furuncle,  relieve 
pain  and  may  abort  its  formation.  Where  this  is  unsuccessful  and 
the  carbuncle  continues  to  progress,  surgical  measures  should  be  insti- 
tuted, an  incision  made,  and  the  fomentation  wrung  out  of  a  hot  anti- 
septic solution  applied  for  ten  minutes  and  repeated  for  ten  minutes 
at  intervals  of  two  to  three  hours.  As  soon  as  the  local  condition  will 
permit,  every  effort  must  be  made  to  build  up  the  patient's  general 
health  and  remove  the  underlying  conditions.  The  author's  experi- 
ence, while  limited,  has  taught  him  that  the  following  method  is  by 
far  the  most  satisfactory:  After  surgical  measures  have  been  insti- 
tuted, the  local  superheated  dry  hot-air  apparatus  is  used  at  a  tem- 
perature ranging  from  300°  to  400°  F.  for  one  hour.  This  may  be 
applied  once,  twice,  or  even  three  times  daily,  but  experience  has 
taught  the  fact  that  the  application  twice  daily  is  sufficient.  Three 
times  a  week  the  body  apparatus  at  a  temperature  of  250°  to  350°  F. 
for  one  hour  must  be  used  to  combat  the  general  condition.  During 
the  existence  of  the  carbuncle  we  may  with  advantage  employ,  between 
the  applications  of  the  superheated  dry  hot-air  body  apparatus,  the 
cold  sponge  at  60°  to  50°  F.,  and  as  soon  as  the  patient  is  up  and  the 
local  lesion  permits  we  may  discontinue  the  local  applications,  give  the 
body  apparatus  every  day,  and  follow  this  with  the  rain  bath  at  75° 
F.  for  one- fourth  to  one-half  minute.  In  a  case  recently  under  the 
author's  care,  a  carbuncle  located  upon  the  forearm,  there  was  entire 
subsidence  of  the  condition  in  eight  days,  an  unusual  result  in  such  an 
affection. 

Comedo;  Milium. 

Black  heads  or  "flesh  worms"  is  a  disorder  of  the  sebaceous  glands, 
characterized  by  the  retention  in  the  excretory  duct  of  the  inspissated 
secretion,  which  becomes  visible  above  the  surface  as  yellowish  or 
whitish  pin-head-sized  elevations,  containing  in  their  centers  blackish 
points.  General  low  health,  anemia,  digestive  disorders,  constipation, 
menstrual  disorders  and  urethral  irritations  are  frequently  back  of 
the  disease,  though  its  exact  etiology  is  unknown.  The  condition  is 
brought  about  by  an  accumulation  of  sebum  and  epithelial  cells  in  the 
glands  and  follicles,  which  dilate  the  duct  so  as  to  produce  the  point 
or  elevation  upon  the  surface.  Comedo  has  a  blackish  appearance 
from  the  dust  and  dirt  that  has  adhered  to  the  surface  of  the  eleva- 
tion. They  are  most  frequently  observed  upon  the  face,  neck,  chest 
and  back,  and  are  very  disfiguring  in  appearance.     There  is,  as  a  rule, 


566  PRACTICAL  HYDROTHERAPY. 

no  evidence  of  inflammation,  but  the  skin  has  a  dirty,  greasy,  un- 
washed appearance.  The  disease  usually  takes  a  chronic  course, 
though  eventually  relieved. 

Milium  is  an  accumulation  of  sebum  in  the  sebaceous  glands  that 
are  without  excretory  ducts,  and  is  characterized  by  the  formation  of 
small,  roundish,  whitish,  non-inflammatory  elevations,  situated  imme- 
diately beneath  the  epidermis.  Its  origin  is  unknown,  though  the 
mechanism  of  its  formation  is  the  prevention  of  the  escape  of  sebum. 
Milia  may  occur  upon  any  portion  of  the  body,  but  it  is  usually  situ- 
ated upon  the  face,  forehead  and  about  the  eyes.  They  are  about  the 
size  of  millet  seeds,  are  usually  round  in  shape,  giving  the  sensation 
to  the  touch  of  a  hard  body  embedded  in  the  skin.  They  are  best  re- 
moved by  opening  the  cyst  with  a  fine-pointed  bistoury. 

The  treatment  of  comedo  and  milium  should  consist  in  the 
careful  regulation  of  the  diet,  forbidding  all  pickles, ,  pastries, 
sweets,  and  the  administration  of  laxatives  and  tonics.  Moderate 
exercise  is  to  be  prescribed ;  general  measures  to  tone  up  the  system 
and  remove  the  underlying  conditions  are  essential.  The  electric  light 
bath  or  the  superheated  dry  hot-air  body  apparatus  will  be  found  ex- 
cellent measures,  to  be  followed  by  the  horizontal  rain  bath  at  100°  to 
102°  F.  for  one  to  two  minutes,  reduced  to  65°  F.  for  one-fourth 
minute. 

The  local  treatment  is  best  applied  as  follows :  Compress  or  the 
fomentation  at  120°  to  130°  F.,  or  as  hot  as  can  be  borne,  is  applied 
to  the  area  affected,  after  which  green  soap  (saponis  viridis)  is  ap- 
plied with  massage,  allowed  to  remain  on  fifteen  to  thirty  minutes, 
washed  off,  the  face  dried,  and  the  comedoes  then  pressed  out  by  means 
of  a  watch  key  or  special  instrument.  The  fomentation  is  then  re- 
applied for  five  minutes,  repeated  for  five  minutes,  and  the  treatment 
finished  by  a  cold  application  for  one-half  to  one  minute. 

Alopecia;  Alopecia  Areata. 

Baldness  is  a  loss  of  hair,  which  may  be  either  partial  or  com- 
plete, congenital  or  acquired,  idiopathic  or  symptomatic.  The  most 
common  form  is  the  symptomatic  one,  which  results  from  infectious 
fevers,  parasitic  diseases  of  the  skin,  eczema,  seborrhea,  syphilis,  lupus, 
etc.  In  the  congenital,  senile  and  idiopathic  varieties  the  hair  seldom 
regenerates,  but  in  the  symptomatic  variety  the  possibility  of  a  new 
growth  or  return  of  hair  is  directly  in  proportion  as  the  cause  is  re- 
movable. 

Alopecia  areata  is  baldness  in  circumscribed  areas ;  these  areas 
occasionally  coalesce,  producing  general  baldness.  Most  cases  are 
due  to  disturbances  of  the  nerves,  while  others  may  be  of  parasitic 
origin.  The  condition  is  one  of  atrophy,  and  affects  the  hair  and  ad- 
jacent skin,  the  most  common  seats  of  the  disease  being  the  scalp, 


DISEASES  OF  THE  SKIN,  EYE  AND  EAR.  5<>7 

beard,  eye-brows,  eye-lashes,  and  occasionally  the  pubic  hair.  The 
patches  are  usually  round,  circumscribed,  smooth  and  white,  with 
very  few  prominent  follicles  or  broken-off  hairs.  The  onset  may  be 
sudden  or  gradual  and  the  duration  indefinite.  Some  cases  date  their 
origin,  as  two  under  the  author's  care,  from  a  sudden  and  profound 
emotion.  The  course  is  chronic,  and  usually  requires  a  period  of 
months  to  bring  about  recovery.  Recovery  in  children  is  the  rule. 
In  older  persons  the  general  health  must  be  corrected,  after  which 
the  hair  usually  returns,  provided  a  protracted  course  of  treatment  is 
followed.     Relapses  are  common. 

The  most  important  element  in  the  treatment  of  these  cases 
is  the  reconstruction  of  the  general  health,  and  it  has  been  the 
author's  experience  that  without  this  little  if  any  good  can  be  accom- 
plished by  other  measures.  Every  form  of  functional  disorder  should 
be  sought  and  corrected,  and  especially  those  in  the  hemic,  digestive, 
secretory  and  excretory  organs.  The  diet  must  be  nutritious  and 
liberal,  with  moderate  exercise  in  the  fresh  air  and  regulation  of  the 
bowel.  The  most  satisfactory  general  method  that  can  be  adopted 
is  that  of  the  electric  light  bath  to  free  perspiration,  followed  by  the 
rain  bath  at  100°  to  104°  F.  for  one  to  one  and  one-half  minutes,  re- 
duced to  80°  F.  for  one-fourth  minute,  pressure  twenty  pounds ; 
reduce  cold  water  two  degrees  daily  to  60°  F.  and  increase  the  pressure 
one  pound  until  thirty  is  registered.  At  this  point  add  to  the  above 
treatment  the  jet  douche  at  60°  F.  for  ten  seconds,  applied  to  the  spine, 
and  the  fan  douche  at  the  same  temperature  to  the  trunk  for  ten  sec- 
onds, taking  special  pains  to  make  the  latter  application  strong  over 
the  abdominal  region. 

Of  local  measures,  the  application  of  cold  water  (60°  to  50°  F.) 
in  the  shape  of  a  shampoo,  once  or  twice  daily,  followed  by  vigorous 
rubbing  or  massage  of  the  scalp,  will  be  found  beneficial.  If  the 
disease  is  parasitic,  an  antiseptic  or  parasiticide  may  be  added  to  the 
water.  Some  authors  speak  very  highly  of  the  stimulating  compress 
at  60°  to  50°  F.  applied  to  the  scalp,  but  the  use  of  this  compress  by 
the  method  suggested  by  Kellogg1  has,  in  the  author's  experience,  been 
by  far  the  best.  A  cheese-cloth  compress,  wet  in  very  cold  water,  is 
applied  to  the  head  after  the  hair  and  scalp  have  been  thoroughly  wet 
in  cold  water  and  shampooed,  over  which  a  rubber  cap  (like  a  lady's 
bathing-cap)  is  then  placed,  thus  covering  the  compress.  By  retaining 
the  heat  the  compress  soon  warms  and  develops  the  usual  effects  of 
such  an  application.  Where  baldness  is  partial  and  the  remainder  of 
the  scalp  is  covered  with  a  healthy  growth  of  hair,  simple  wetting 
and  covering  with  a  rubber  cap  is  sufficient  to  develop  the  full  effects. 

It  will  be  observed  at  once  that  this  is  a  nice  way  of  applying  the 
stimulating  compress.     The  author  would  like  to  call  attention  to  the 

1   Kellogg,   J.    H. :    "Modern   Hydrotherapy." 


568  PRACTICAL  HYDROTHERAPY. 

fact  that  the  rubber  cap  should  not  fit  so  tightly  as  to  in  any  wise 
compress  the  skin  of  the  scalp  and  interfere  with  the  circulation  of 
the  blood  therein. 

Hyperidrosis. 

Hyperidrosis  is  a  disorder  of  the  sweat-glands,  characterized  by  an 
increased  secretion  of  sweat,  which  may  be  either  general  or  partial, 
unilateral  or  bilateral.  It  is  usually  brought  about  by  some  disorder 
of  the  sympathetic  nervous  system,  although,  in  some  cases  it  is  inher- 
ited. 'Its  origin  is  unknown,  but  the  condition  is  functional  in  char- 
acter. The  author  has  seen  quite  a  good  many  cases  associated  with 
neurasthenia.  The  disorder  may  be  acute  or  chronic,  constant  or  par- 
oxysmal, and  the  quantity  of  sweat  small  or  large.  Localized  sweat- 
ings have  occurred  most  frequently  in  the  author's  experience,  upon 
the  hands,  the  feet  and  face,  in  the  order  named.  I  have  had  half  a 
dozen  interesting  cases  of  unilateral  facial  hyperidrosis.  Where  it 
occurs  upon  the  palms  it  may  be  so  profuse  as  to  keep  the  skin  of 
the  hands  constantly  soft  and  prevent  the  sufferer  from  wearing 
gloves.       This  condition  is  very  common  in  alcoholics. 

Hyperidrosis  of  the  soles  of  the  feet  is  a  disagreeable  and  distress- 
ing condition,  as  the  shoes  and  socks  become  saturated  with  perspira- 
tion, and  as  it  cannot  evaporate  rapidly  through  the  leather  nor  be 
wiped  off,  the  epidermis  macerates  and  the  skin  becomes  tender, 
causing  much  pain  and  distress.  The  maceration  of  the  epidermis 
and  the  retention  of  the  secretion  from  the  toes  produces  a  most  dis- 
agreeable, persistent  and  disgusting  odor,  which  oftentimes  prevents 
the  individual  from  seeking  the  society  of  his  fellows.  It  is  equally 
true  of  hyperidrosis  of  the  genitalia.  These  cases  are,  as  a  rule,  intrac- 
table and  difficult  of  cure.     Relapses  occur  with  great  frequency. 

In  a  somewhat  extended  experience  in  the  management  of 
these  local  manifestations  of  nervous  disorder,  the  author  has 
found  that  powerful  hydriatic  applications  in  the  form  of  general 
treatment,  together  with  localized  applications,  will  generally  prove 
to  be  satisfactory,  but  time  is  required  to  overcome  the  different  dis- 
orders of  the  system  that  underlie  the  neurosis.  Commence  with  the 
electric  light  bath  or  the  hot-air  bath  to  the  point  of  free  perspiration, 
or  the  superheated  dry  hot-air  body  apparatus  for  thirty  to  sixty  min- 
utes. Follow  this  with  the  horizontal  rain  bath  at  100°  to  102°  F. 
for  one  to  two  minutes,  reduced  to  80°  F.  for  one-fourth  minute, 
pressure  thirty  pounds ;  reduce  the  cold  water  two  degrees  daily  to  60° 
F.  As  soon  as  this  lower  temperature  has  been  reached  give  the  fol- 
lowing: Electric  light  bath  and  rain  bath  as  above,  followed  by  the 
jet  douche  to  the  spine  and  posterior  aspect  of  the  lower  limbs  at 
60°  F.,  pressure  thirty  pounds,  for  ten  seconds,  and  the  fan  douche 
at  the  same  temperature  to  the  body,  especially  the  abdomen,  as  strong 


DISEASES  OE  THE  SKEW  EYE  AXD  EAR.  569 

as  can  be  borne,  for  ten  seconds.     As  soon  as  the  patient  stands  this 
treatment  well   we  may  give  the   following,  which   should  never  be 
administered  to  a  weak  patient  or  to  those  who  are  slow  in  reacting: 
Electric  light  bath  to  free  perspiration,  followed  by  the  Scottish  or 
alternating  douche  at  102°  to  105°  R,  applied  in  the  shape  of  a  jet 
douche  to  the  spine  and  a  fan  to  the  body  for  one-fourth  to  one-half 
minute,  alternating  in  the  same  manner  with  a  temperature  of  60° 
R,  five  seconds  to  the  spine  and  five  seconds  to  the  body,  four  to  six 
alternations.     The  termination  of  this  treatment  should  always  be  the 
fan  douche  to  the  body,  or,  what  is  better,  terminate  the  treatment 
with  this  douche  applied  to  the  upper  surfaces  and  soles  of  the  feet. 
The  author  has,  however,  found  that  the  best  method  is  to  use  the 
Scottish  or  alternating  douche  as  above  described  and  the  alternate 
hot  and  cold   foot-bath   as  a  finishing  treatment,  or  the  simple  cold 
foot-bath  at  60°  to  50°  F.  one-fourth  to  one  minute.     This  treatment 
should  be  administered  during  the  day  and  the  patient  instructed  to 
bathe  the  parts  with  certain  astringent  lotions  at  bedtime.     To  the 
feet  we  should  applv  a  strong  solution  of  permanganate  of  potash, 
drachms  one  or  two  to  the  pint  of  water;    to  the  face  and  hands  a 
strong  solution  of  tannic  acid. 

Anidrosis. 

Anidrosis  is  a  functional  disorder  of  the  sweat-glands  of  the  skin, 
characterized  by  diminished  or  insufficient  secretion  of  perspiration. 
Some  skins  naturally  do  not  secrete  a  sufficiency  of  perspiration,  and 
this  may  be  a  family  trait.     It  oftentimes  accompanies  nerve  injuries, 
but  has,  in  the  author's  experience,  been  most  commonly  found  where 
the  -eneral  health  is  impaired,  and  especially  in  those  diseases  in  which 
the  digestive  and  renal  systems  were  at  fault.     It  is  a  disorder  that 
may  cause  a  great  deal  of  suffering  in  hot  weather,  and  in  a  certain 
sense  subjects  the  sufferer  to  insolation.     It  has  been  the  author  s  ex- 
perience that  where  it  is  not  due  to  a  congenital  deficiency  of  the  sweat- 
glands  or  to  irremediable  nerve  influences,  it  is  generally  more  easily 
treated  and  more  satisfactory  results  obtained  than  in  hypendrosis 
The    important    element,    of    course,    should    be    to    correct    all 
those   conditions   or    factors   that   are   producing  or   aggravating  the 
condition,  and  institute  treatment  that  will   stimulate  the  activity  of 
the  skin  and  sweat-glands.     The  patient  should  be  instructed  in  hy- 
gienic laws,  digestive  disorders  corrected,  constipation  overcome,  and 
renal  and  cutaneous  activity  stimulated  by  the  frequent  ingestion  of 
water.     Hot  procedures  are  of  benefit  in  these  conditions,  and  the 
Turkish  bath  has  gained  quite  a  reputation  with  these  sufferers.     We 
mav  administer  the  electric  light  bath  or  hot-air  bath  to  the  point  of 
free  perspiration  ;  the  superheated  dry  hot-air  body  apparatus  at  2:>0 
to  300°  R  for  thirty  to  sixty  minutes;  the  hot  full  bath  at  100°  to 


570  PRACTICAL  HYDROTHERAPY. 

105°  F.,  or  even  110°  F.,  if  possible,  for  five  to  ten  minutes;  or  the 
full  wet  pack  at  65°  F.  for  one  hour.  The  aim  of  these  measures  is 
to  dilate  the  blood-vessels,  stimulate  the  glands  and  increase  the  secre- 
tion of  perspiration.  Tonic  reaction,  by  means  of  which  the  blood  is 
retained  in  the  skin  and  glandular  activity  stimulated,  can  only  be 
brought  about  by  following  the  heating  procedure  by  cold  applica- 
tions. Selecting  any  of  the  foregoing,  we  may  follow  the  applica- 
tion with  the  dripping  sheet  at  60°  to  50°  F.  for  three  minutes,  with 
vigorous  friction,  the  half  bath  at  65°  to  60°  F.  for  two  to  five  min- 
utes, in  conjunction  with  the  affusion  to  the  body;  the  horizontal  rain 
bath  at  65°  F.  for  one-fourth  minute,  pressure  thirty  pounds;  or  the 
jet  douche  to  the  spine  and  fan  douche  to  the  body,  especially  the  ad- 
domen,  at  60°  F.  for  ten  to  twenty  seconds,  pressure  thirty  pounds. 
In  some  cases,  as  an  after-treatment,  it  will  be  found  beneficial  to  give 
short  rubbings  or  friction,  using  at  the  same  time  cocoa-nut  oil.  This 
will  tend  to  prevent  the  skin  from  becoming  dry  and  harsh  in  the  inter- 
vals between  treatments  until  full  effects  are  obtained. 

Sudamina;  Miliaria. 

Sudamina  is  a  non-inflammatory  affection  of  the  sweat-glands, 
characterized  by  the  development  of  millet-seed-sized,  translucent, 
whitish  vesicles  in  great  number  upon  any  portion  of  the  body.  The 
usual  cause  of  the  disorder  is  high  bodily  temperature,  causing  unusual 
activity  of  the  sudoriparous  glands,  which  are  excited  beyond  their 
capacity  for  normal  secretion ;  the  excessive  fluid,  instead  of  escaping 
upon  the  surface,  collects  between  the  layers  of  the  epidermis  in  the 
form  of  minute  translucent  vesicles.  It  is  a  short-lived  rash,  the 
vesicles  of  which  are  distinct  and  resemble  in  appearance  drops  of  free 
sweat;  they  never  become  puriform.  The  fluid  is,  as  a  rule,  rapidly 
dissipated  and  the  vesicles  dry,  leaving  membranes  which  desquamate 
without  scar. 

Miliaria,  or  "prickly  heat,"  is  an  acute  inflammation  of  the  sweat- 
glands,  characterized  by  the  development  of  reddish,  pin-point-  or 
millet-sized  papules,  vesicles  or  vesico-papules,  accompanied  by  prick- 
ling, tingling  and  burning  sensations  of  a  most  aggravated  character, 
often  associated  with  more  or  less  malaise.  Excessive  heat  or  the 
retention  of  heat  by  tightly-fitting  clothing,  or  high  external  tempera- 
ture usually  produces  the  eruption.  The  affection  is  most  common  in 
fleshy  adults  who  perspire  freely  and  in  young  children  whose  skins 
are  exceedingly  sensitive.  Neurasthenia,  digestive  disorders  and  gen- 
eral debility  favor  the  eruption.  It  is  an  inflammatory  affection  due 
to  an  excessive  discharge  from  the  sweat-glands,  which  develop  ves- 
icles and  papules  about  the  orifices  of  the  excretory  ducts  in  the  skin. 
Hyperemia  of  the  vascular  plexus  of  the  sweat-glands  occurs,  followed 
by  exudation  and  elevation  of  the  vesicle,   which  may  remain  until 


DISEASES  OE  THE  SKEW  EVE  AND  EAR.  571 

the  irritation  has  been  removed,  when  the  eruption  rapidly  subsides. 
Heat  rash  or  prickly  heat  is  of  sudden  onset,  and  is  usually  a  most 
disagreeable  and  distressing  affection.  It  occurs  most  frequently  on 
the  abdomen,  chest,  back,  neck  and  arms.  In  children  it  is  usually 
accompanied  by  a  state  of  great  irritability.  It  may  occur  and  disap- 
pear within  a  few  hours,  but  in  those  who  are  predisposed  it  usually 
continues  in  different  degrees  during  the  summer  heat.  In  the  fleshy 
and  in  those  who  cat  much  meat  the  disease  may  be  continuous. 

The  ideal  treatment  would,  of  course,  be  removal  to  a  tem- 
perature sufficiently  cool  to  prevent  an  occurrence  of  the  eruption, 
but  where  this  is  impossible  the  patient  should  be  kept  cool  and  avoid 
exertion,  meat  and  condiments.  They  should  be  instructed  to  drink 
freely  of  water,  plain  or  carbonated,  to  which  potassium  citrate  or 
bitartrate  has  been  added.  Sometimes  the  use  of  large  doses  of  an 
saline  cathartic  will  remove  the  irritation.  The  best  general  method 
of  treating  this  affection  is  the  use  of  the  full  neutral  bath  at  90°  to 
92°  F.  for  twenty  to  sixty  minutes,  once,  twice  or  three  times  daily 
if  necessary.  The  local  application  of  the  cold  or  cooling  compress 
or  the  sponge  with  alkaline  solutions  at  60°  to  50°  F.  will  give  tem- 
porary relief. 

Few  physicians  understand  the  hydriatic  method  by  wdiich  we  may 
keep  cool  in  summer,  especially  at  night.  Those  who  are  compelled  to 
remain  in  heated  districts,  especially  the  urban  population,  can  by  the 
use  of  simple  hydrotherapy  secure  a  good  night's  rest  and  relief  from 
the  disagreeable  effects  of  the  heated  term.  It  should  be  borne  in 
mind  that  cold  baths  are  tonic,  stimulating,  and  in  their  application 
heat  is  produced  as  a  result  of  its  influence  upon  the  circulation,  metab- 
olism and  the  thermogenetic  centers  in  the  central  nervous  system, 
for  the  sudden  application  of  cold  stimulates  these  centers  to  greater 
activity,  and  at  the  same  time  causes  redistribution  of  the  surface 
blood.  If  we  wish  to  reduce  the  temperature  by  cold  methods  we 
must  utilize  the  Brand  bath — that  is  to  say,  the  full  cold  bath  with 
friction.  In  the  heated  season  there  is  nerve  exhaustion,  lack  of  phys- 
ical capacity  and  an  irritation  that  demands  soothing  applications, 
and  nothing  that  will  stimulate  or  increase  the  heat.  It  was  the  Eng- 
lish who  long  ago  found  that  in  the  heated  and  humid  climate  of  India 
those  who  bathed  in  a  tepid  or  neutral  temperature  remained  in  a 
better  condition  to  "stand  the  climate"  than  those  who  used  cold  baths. 
The  aim  should  be  to  prevent  heat  formation,  and  to  this  end  we  may 
use  the  following  method :  The  tub  is  filled  with  water  at  a  tempera- 
ture of  90°  to  96°  F. — that  is  to  say,  a  neutral  temperature — in  which 
the  individual  should  remain  from  ten  to  thirty  minutes.  Where  it  is 
taken  in  the  morning  the  person  may  dry  himself  with  little  or  no 
friction,  and  endeavor  thereafter  to  avoid  muscular  exertion.  At 
bedtime,   however,  the  person  should,  upon  stepping  from  the  bath, 


572  PRACTICAL  HYDROTHERAPY. 

put  on  a  night  dress,  preferably  linen,  without  removing  any  of  the 
surplus  water.  In  this  way  the  night  dress  becomes  moistened  to  a 
moderate  degree,  encasing  the  individual  in  a  mild  moist  pack,  which 
cools  the  surface  continually  by  slow  evaporation.  If  desired,  the 
lounge  or  bed  may  be  likewise  sprinkled,  and  should  the  individual 
awake  during  the  night  a  redampening  of  the  night  dress  will  often- 
times be  all  that  is  necessary  to  secure  continued  relief  from  heat. 
Should  a  draught  be  present,  care  must  be  taken  to  avoid  being  in  its 
direct  path,  but  usually  where  this  is  present  the  bath  is  not  needed. 

Seborrhea. 

Seborrhea  is  a  functional  disorder  of  the  sebaceoum  glands  of  the 
skin,  characterized  by  excessive,  diminished  or  abnormal  secretion 
of  sebaceous  matter,  forming  upon  the  skin  a  coating,  crust  or  scale. 
The  origin  of  the  disease  is,  as  a  rule,  not  known,  but  it  occurs  with 
a  great  degree  of  frequency  in  those  who  are  anemic.  It  is  a  func- 
tional disorder  that  may  terminate  in  atrophy  of  the  glands.  It  occurs 
most  frequently  upon  the  scalp  and  face,  appearing  as  a  greasy  coat- 
ing upon  the  skin,  unattended  with  itching.  This  secretion  is  some- 
times so  great  as  to  collect  in  minute  drops  of  yellowish  fluid.  It 
affects  the  face  most  frequently,  and  is  usually  worse  about  the  nose. 
In  some  instances  there  is  a  more  or  less  greasy  mass  of  scales  or 
crusts  of  a  grayish  or  brownish-yellow  color,  which  stick  to  the  skin 
and  itch  moderately.  Seborrhea  of  the  scalp  oftentimes  causes  falling 
of  the  hair  and  even  premature  baldness.  Recovery  is  usually  made 
from  this  affection,  although  it  is  slow.  Especial  attention  should  be 
paid  to  the  variety  that  affects  the  scalp. 

Here,  again,  the  general  health  is  what  demands  the  greatest 
share  of  our  attention.  Disorders  of  the  blood,  digestion  and 
elimination  must  be  corrected,  together  with  the  prevention  of  intes- 
tinal toxemia,  before  success  will  crown  our  efforts.  Regulate  the 
hygienic  side  of  life,  correct  underlying  factors,  better  the  blood  and 
circulation,  and  a  step  will  have  been  taken  which  frequently  of  itself 
is  sufficient  to  cure  the  disorder.  Hydrotherapy,  by  restoring  normal 
circulation,  bettering  innervation  and  improving  secretion,  is  a  method 
that  will  give  excellent  results  in  seborrhea.  The  electric  light  bath 
is  by  far  the  best  measure,  followed  by  the  rain  bath  at  102°  to  104° 
F.  for  one  to  two  minutes,  reduced  to  80°  F.  for  one-fourth  minute, 
pressure  thirty  pounds ;  reduce  the  temperature  of  the  cold  water 
two  degrees  daily  to  60°  F.  As  soon  as  this  temperature  has  been 
reached  add  to  the  above  treatment  at  60°  F.,  pressure  twenty  pounds, 
the  jet  douche  to  the  spine  and  posterior  aspect  of  the  lower  limbs 
and  the  fan  douche  to  the  body.  This  treatment  should  be  combined 
with  local  cleansing  measures  and  applications.  The  scales  or  crusts 
are  first  removed  and  then  the  scalp  or  the  part  affected  treated  by 


DISEASES  OE  THE  SKIN,  EVE  AND  EAR.  573 

means  of  the  stimulating  compress  or  cap,  as  suggested  by  Kellogg. 
Shampooing  the  affected  area  two  or  three  times  daily  will  oftentimes 
give  great  relief  and  relieve  local  manifestations. 

Pruritis. 

Pruritus  is  a  functional  disorder  of  the  skin,  characterized  essen- 
tially by  itching  without  any  obvious  cause.  Sometimes  it  is  idiopathic, 
but  the  greater  number  of  cases  are  symptomatic  and  dependent  upon 
general  conditions.  Idiopathic  pruritus  is  oftentimes  diagnosed,  but 
it  has  been  the  author's  experience  that  a  careful  and  extended  search 
of  the  particular  case  wiil  usually  detect  the  underlying  conditions, 
the  removal  of  which  will  remove  the  pruritus.  (See  "Pruritus 
Vulva?.-'  I 

In  the  treatment  of  pruritus  all  underlying  causes  should  be 
first  removed  and  the  treatment  of  pruritus  itself  modified  to 
meet  the  condition  found  to  be  present.  By  far  the  best  hydriatic 
method  is  the  prolonged  neutral  bath  at  92°  to  94°  F.  for  one  hour, 
twice  or  three  times  daily.  In  two  cases  of  general  pruritus  the  author 
has  been  able  to  relieve  the  terrible  suffering  by  means  of  the  very  hot 
fan  douche  at  105°to  110°  F.,  if  possible  115°  F.,  for  one  to  two 
minutes,  applied  to  the  entire  cutaneous  surface,  reduced  to  80°  to 
60°  F.  for  one-fourth  to  one-half  minute.  This  application  was  made 
during  the  daytime,  and  at  bedtime  the  neutral  bath  for  one  hour  was 
administered,  together  with  free  water-drinking;  both  cases  recovered 
and  have  since  remaftied  well.  Some  writers  speak  highly  of  the 
action  of  the  Xauheim  or  effervescing  bath  in  pruritus,  but  of  this 
the  author  has  had  little  or  no  experience. 

Bed-Sores. 

A  bed-sore  is  a  lesion  of  the  cutaneous  surface  that  occurs  in 
acute  or  chronic  diseases  from  various  causes,  being  especially  prone 
to  attack  tissues  whose  nerve  supply  has  been  cut  off.  They  are  often- 
times a  source  of  danger  to  the  patient  because  of  the  infection  that 
may  occur  and  distress  because  of  the  discharge  and  pain.  They  can 
best  be  prevented  by  scrupulous  cleanliness,  the  use  of  alternating  hot 
and  cold  application  several  times  daily,  and  the  prevention  of  pressure. 
The  thermic  applications  in  alternation  stimulate  the  circulation,  im- 
prove nerve  action  and  prevent  infection.  The  application  is  best 
made  by  the  alternating  application  of  the  compress  wrung  out  of 
water  at  130°  to  160°  F.  and  60°  to  50°  F.  It  was  in  the  treatment 
of  burns  and  bed-sores  that  Reiss  obtained  his  marvelous  results  in 
the  use  of  the  neutral  continuous  bath,  and  there  is  at  the  present  day 
no  method  more  satisfactory.  The  patient  may  remain  in  the  bath 
during  the  day  hours  and  at  night  be  placed  in  bed.  The  skin  must 
be  annointed  with  an  oleate  once  daily. 


574  PRACTICAL  HYDROTHERAPY. 

Cold  Hands  and  Feet. 

Habitual  coldness  of  the  hands  and  feet  is  an  annoying  symptom 
to  a  great  many  people  who  are  out  of  health,  who  are  anemic  and 
nervously  exhausted.  In  the  treatment  of  the  general  condition  from 
which  they  are  suffering  these  local  symptoms  pass  away,  for,  as  a 
rule,  the  general  tonic  hydriatic  measures  instituted  for  the  relief  of 
the  underlying  cause  will  prove  sufficient,  but  the  conditions  may  be 
greatly  benefited  by  the  additional  use  of  local  applications.  Many 
of  these  patients  will  be  found  to  have  disturbances  of  the  sympa- 
thetic nervous  system  or  some  interference  with  their  nutrition,  as 
a  result  of  which  the  extremities  are  reflexly  cold.  Many  simple 
measures  may  be  mentioned — the  alternate  hot  and  cold  foot-bath, 
the  former  at  105°  to  110°  F.  for  one- fourth  to  one-half  minute  and 
the  latter  at  60°  to  50°  F.  for  ten  to  fifteen  seconds,  three  to  four 
alternations.  In  the  same  manner  the  alternating  Scottish  douche 
applied  to  the  soles  and  upper  surface  of  the  feet  at  the  same  temper- 
atures and  durations  as  above  will  give,  as  a  rule,  very  prompt  results. 
Kellogg2  recommends  the  cold  douche  to  the  palms  of  the  hands  and 
soles  of  the  feet,  where  these  are  affected,  at  60°  to  50°  F.  for  one- 
half  to  one  minute  and  the  cold  compress  or  the  alternating  hot  and 
cold  compress  where  the  face  is  the  region  affected.  Those  cases  in 
which  the  sympathetic  nervous  system  is  involved  should  have  the 
fomentation  applied  to  the  abdomen  for  ten  minutes,  followed  by  the 
trunk  pack  or  abdominal  compress  at  65°  F.  for  thirty  to  sixty  min- 
utes. The  author  has  found  that  the  foot-bath  at  60°  to  50°  F.,  in 
which  the  temperature  is  maintained  by  constantly  flowing  water,  is 
very  effective,  especially  where  we  have  to  deal  with  cold  feet  alone. 
After  these  treatments  the  use  of  the  oil  rub  accompanied  by  friction 
will  be  found  serviceable  and  enhance  the  action  of  hydrotherapeutic 
measures. 

Leprosy. 

Leprosy,  the  "Unclean"  of  the  Scripture,  is  a  chronic,  contagious 
and  infectious  disease  produced  by  the  bacillus  leprae,  characterized 
by  the  formation  of  new  growths  in  the  skin,  peripheral  nerves  and 
internal  viscera,  producing  various  deformities  and  mutilations  and 
usually  ending  fatally.  It  appears  usually  in  two  distinct  forms,  the 
nodular  and  anesthetic.  Its  period  of  incubation  extends  over  a  period 
of  from  a  few  weeks  to  many  years.  The  ultimate  physical  condition 
of  the  unfortunate  victim  of  leprosy  cannot  be  equalled  in  any  other 
disease.  Leloir3  says  if  the  patient  does  not  die  of  some  intercurrent 
disease  or  special  complication,  the  unhappy  leper  becomes  a  terrible 
object  to  look  upon.        His   deformed   leonine    face   is  covered   with 

2  Kellogg,   J.    II.:    Ibidem. 
3   Quoted  by  G.   Tbinn,  "Leprosy,"   1891. 


DISEASES  OF  THE  SKIN,  EVE  AND  EAR.  575 

tubercles,  ulcers,  cicatrices  and  crusts ;  his  sunken,  disfigured  nose  is 
reduced  to  a  stump,  his  respiration  is  wheezy  and  difficult,  he  breathes 
with  the  greatest  difficulty,  loses  his  voice,  his  eyes  and  sight  are 
destroyed.  The  patient  surfers  excruciating  pains  in  his  limbs,  while 
the  ravages  of  the  diseases  in  his  legs  render  walking  difficult  and 
even  impossible.  In  spite  of  his  condition,  the  unhappy  leper,  al- 
though in  great  prostration,  commonly  preserves  his  intelligence  un- 
affected to  the  end. 

In  the  anesthetic  variety  the  bacilli  are  located  chiefly  in  the  neu- 
roglia of  the  peripheral  nerves.  This  form  develops  slowly,  its 
average  duration  being  estimated  at  about  eighteen  years.  The  lesions 
vary  from  the  size  of  a  fifty-cent  piece  to  that  of  the  palm  or  larger. 
They  are  usually  reddish  in  color  at  first,  changing  to  a  yellowish, 
brownish  or  even  darker  shades.  Their  centers  become  depigmented 
and  anesthetic,  while  the  border  may  be  hyperpigmented  and  hyper- 
esthetic.  Their  commonest  seats  are  usually  the  back,  shoulders,  face, 
arms,  nates  and  around  the  knees.  When  the  nerve  trunks  are  the 
seat  of  severe  neuritis  they  become  much  thickened  and  can  be  readily 
felt  by  the  examining  finger.  Atrophic  changes  are  first  noticed  in 
the  interosseous  muscles  of  the  hand,  the  thenar  and  hypothenar  being 
next  involved,  the  atrophy  extending  thence  up  the  arms,  producing 
the  "lepra  claw."  The  same  process  may  occur  in  the  feet  and  the 
muscles  of  the  face,  making  it  expressionless.  Perforating  ulcers  of 
the  foot  may  occur  and  other  trophic  lesions. 

Any  method  or  measure  that  would  aid  or  ameliorate  such 
a  heartrending  condition  is  worthy  of  consideration  and  trial.  The 
author  has  no  personal  experience  and  knowledge  concerning  the 
management  of  leprosy,  but  two  recent  communications  upon  the 
subject  demand,  in  his  opinion,  consideration.  Duque4  says  that  the 
use  of  the  red  mangrove  and  the  full  hot  bath  is  very  beneficial.  The 
mangrove,  as  prepared  according  to  the  formula  of  Dr.  Morena  him- 
self, is  as  follows: 

Ground  plant  1000  grams 

Alcohol 200       "n 

Glvcerine  350 

Water    450       " 

From  which  a  dose  should  be  taken  in  the  morning  and  afternoon 
of  one  teaspoonful  of  the  equivalent  of  seven  grams;  increase  the 
dose  every  eight  days  by  taking  one  teaspoonful  more  until  eight, 
ten  or  twelve  spoonfuls  are  taken  at  a  dose. 

The  full  bath  should  cover  the  entire  body  and  be  taken  on  going 
to  bed  at  a  temperature  of  from  39°  to  40°  Centigrade,  or  as  hot  as 
the  patient  is  able  to  endure  it.  The  duration  ranges  between  fifteen 
and  twenty  minutes,  care  being  taken  that  the  temperature  is  main- 

4  Duque,  Matias:   "The  Treatment  of  Leprosy,"  American  Journal  of  Dermatology,   1907. 


576  PRACTICAL  HYDROTHERAPY. 

tained,  that  the  body  be  immediately  wiped  and  thoroughly  dried 
without  rubbing  or  friction  whatsoever,  and  the  patient  retiring  at 
once  to  bed,  well  wrapped.  The  bath  is  more  efficacious  if  a  decoc- 
tion of  the  mangrove  is  added  in  sufficient  quantity  to  redden  the 
water  used  in  the  bath. 

Hollmann5  says  that  all  lepers  can  take  the  medicated  baths  and 
be  benefited,  but  the  most  improvement  has  been  observed  in  those 
suffering  from  ulcerated  tubercles  and  those  who  have  thickened  and 
lifeless  skin,  or  where  there  are  neuritic  pains  or  the  lepra  itch. 
The  plain  warm  full  bath  of  soft  water  at  a  temperature  of  95°  to 
104°  F.  assist  the  work  of  ameliorating  the  condition  of  the  lepers 
by  carrying  off  the  effete  material  from  the  system  and  removing  all 
crusts  and  scabs.  The  hot  full  bath  at  105°  to  110°  F.  is  a  powerful 
stimulant,  and  is  usually  succeeded  by  sleep  in  leprous  patients.  The 
medicated  bath,  of  which  he  speaks  in  detail,  is  given  at  the  above 
temperatures  in  a  tub  containing  thirty  to  forty  gallons  of  water,  to 
which  is  added  four  gallons  of  the  medicated  mixture,  which  is  made 
as  follows :  The  leaves  and  tender  sprouts  of  the  eucalyptus,  which 
are  covered  with  water  in  a  still,  boiled  for  two  hours  and  strained ; 
add  carbolic  acid  (1:4000)  and  sodium  hyposulphite  (1:50). 

The  bath  is  given  twice  daily.  In  the  morning  it  should  be  at  a 
temperature  of  95°  to  104°  F.,  duration  fifteen  minutes.  During  the 
immersion  active  friction  should  be  kept  up  on  all  parts  of  the  body. 
Immediately  after  the  bath  the  patient  should  be  thoroughly  rubbed 
with  a  towel  coarse  enough  to  give  exercise  to  the  skin.  In  the 
evening  the  bath  should  be  at  a  temperature  of  105°  F.,  gradually 
raised  to  110°  F.,  or  as  hot  as  the  patient  can  endure  it.  Its  duration 
ranges  from  ten  to  fifteen  minutes,  at  the  end  of  which  time  the 
patient  should  be  removed  and  wrapped  in  a  warm  blanket  and  allowed 
to  remain  thus  covered  for  ten  minutes. 

Benefit  has  followed  in  nearly  every  case,  only  three  out  of  four 
hundred  cases  being  unbenefited.  The  author  notes  the  following 
results :  Cleanliness ;  when  a  person  is  afflicted  with  an  incurable 
disease  in  a  vast  majority  of  cases  he  becomes  more  or  less  careless 
and  neglects  his  daily  bath.  There  is  an  absence  of  the  peculiar  odor 
and  a  lessening  of  the  danger  of  contagion  from  attack.  The  glands 
of  the  skin  are  stimulated  and  goaded  to  a  proper  functional  activity. 
The  action  is  so  great  that  patients  have  noticed  a  collection  of  effete 
material  after  the  bath.  It  changes  the  appearance  of  the  skin,  which 
becomes  clearer,  cleaner,  brighter  and  healthier  looking.  It  softens 
the  thickened,  indurated  and  underlying  integument,  so  that  the  skin 
becomes  softer  and  more  pliable,  with  a  disappearance  of  some  of  the 
thickened  ridges  which  cause  the  "leonine"  facies.     The  stiffness  and 


5   Hollman,    Harry   T. :    '"The   Use   of   Baths   in   the   Treatment   of   Leprosy,   Especially   the 
Medicated  Bath,"  New  York  Medical  Journal,   May  11,   1907. 


DISEASES  OF  THE  SKIN,  EYE  AND  EAR.  577 

contractures  in  the  ringers  are  relieved  as  well  as  the  neuritis.  This 
intractable  nerve  pain  is  more  relieved  by  the  baths  than  from  any 
drug  internally.  The  itch  disappears,  excoriations,  ulcerations, 
erosions  and  abrasions  of  the  skin  and  mucous  membrane  are  rapidly 
healed,  while  the  leprous  tubercles  soften  and  gradually  disappear; 
the  insomnia  is  relieved.  The  reports  from  these  observers  should, 
at  least,  merit  trial,  and  if  found  to  be  efficacious  will  be  but  another 
star  in  the  broad  firmament  of  hydrotherapy's  many  successes. 

Skin  Diseases  in  General. 

In  the  hydrotherapeutic  treatment  of  diseases  of  the  skin  other 
than  those  that  have  heretofore  been  detailed  it  may  be  stated  in 
general  terms,  barring  special  cases,  that  dry  and  scaly  eruptions  de- 
mand treatment  that  will  bring  about  more  or  less  softening  or  macera- 
tion, which  is  best  met  by  the  non-irritating  neutral  bath  at  90°  to 
92°  F.  for  thirty  to  sixty  minutes,  to  which  an  alkali  has  been  added, 
the  best  being  bicarbonate  of  soda,  one  drachm  to  the  gallon.  If 
the  eruption  is  moist,  irritable  and  pruritic,  use  a  compress  saturated 
in  a  cool  or  cold  alkaline  solution,  or  immersion  in  a  cool  alkaline  bath 
at  75°  F.  for  ten  to  twenty  minutes,  repeated  once  or  twice  daily.  If 
the  skin  is  being  destroyed  or  damaged  by  pressure  or  irritation,  either 
in  whole  or  in  part,  we  should  use  the  neutral  continuous  bath  of  the 
whole  body  or  of  the  part  affected,  as  suggested  by  Reiss. 

Eye  and  Ear. 

The  eye  and  ear  are  subject  to  certain  inflammations,  the  result  of 
infection,  trauma  or  other  irritation,  and  hydrotherapeutic  applications 
may  serve  a  useful  though  subsidiary  part.  In  many  instances  they 
give  prompt  and  satisfactory  relief  to  pain  and  suffering,  prevent  the 
extension  and  further  involvement  of  delicate  and  valuable  structures, 
aid  other  measures  and  soothe  the  patient.  The  ophthalmic  surgeon 
will  find  a  useful  ally  in  these  simple  but  none  the  less  valuable 
methods,  and  will  doubtless  find  herein  a  field  too  little  trodden  save 
by  the  hydriatist. 

If  the  eyelids  are  the  only  structures  involved,  and  if  the 
inflammation  is  acute,  nothing  equals  the  application  of  the  cold 
compress  at  60°  to  50°  F.,  renewed  every  twenty  to  thirty  minutes, 
oftener  in  the  very  early  stages,  longer  in  the  later  stages  as  improve- 
ment takes  place.  The  author  has  tried  with  considerable  satisfaction 
in  several  cases  the  method  suggested  by  Kellogg  of  a  very  gentle 
douche  as  hot  as  can  be  borne  upon  the  external  surface  of  the  lids 
and  forehead,  it  being  equally  valuable  in  acute  and  chronic  inflamma- 
tion of  the  lids.  This  treatment  should  be  given  twice  daily  where 
stimulation  is  needed,  and  be  followed  by  the  very  brief  cold  compress 
for  fifteen  to  thirty  seconds  at  50°  to  40°  F.     Where  the  eyelid  has 


578  PRACTICAL  HYDROTHERAPY. 

been  subjected  to  trauma  and  where  there  is  contusion,  ecchymosis 
or  subsequent  irritation,  resulting  in  a  high  degree  of  inflammation, 
accompanied  by  great  pain,  nothing  will  be  found  more  soothing  than 
the  use  of  the  very  cold  or  ice  compress.  A  block  of  ice  is  taken  and 
several  cheese  cloths  or  linen  compresses  prepared.  These  are  placed 
upon  the  block  and  when  thoroughly  chilled  applied  to  the  inflamed 
area.  As  soon  as  one  compress  begins  to  warm  it  is  removed,  another 
applied,  the  excess  water  squeezed  out  of  the  one  removed  and  it  again 
placed  upon  the  block  of  ice.  The  compresses  are  thus  applied  in 
rotation  and  the  cold  application  continuously  maintained.  The  aim 
should  be  to  obtain  the  contracting  influence  of  low  temperatures  of 
cold  upon  the  peripheral  blood-vessels,  its  anesthetic  influence  upon 
the  nerves,  and  its  antiphlogistic  action  upon  the  tissue. 

In  ulcerations  of  the  cornea,  in  inflammations  of  the  cornea,  in 
degenerative  states,  in  interstitial  and  phlyctenular  keratitis,  infected 
corneal  "a'ounds,  hypopyon,  suppurative  panophthalmitis,  in  hyperemia, 
in  muscular  spasm,  in  iritis  and  cyclitis,  in  injuries  of  the  deeper 
structures  of  the  eyeball,  the  most  satisfactory  application  is  the 
fomentation  at  130°  to  140°  F.,  applied  to  the  eye  and  forehead  for 
ten  minutes,  repeated  for  ten  minutes,  followed  by  the  cold  stimulating 
compress  for  one  or  two  hours,  at  the  end  of  which  time  the  fomenta- 
tion may  be  repeated. 

In  contusions,  commonly  known  as  "black  eye,"  the  fomentation 
at  120°  to  130°  F.  for  ten  minutes,  repeated  for  ten  minutes,  followed 
by  the  stimulating  compress  at  60°  to  50°  F.  for  two  to  three  hours, 
will  generally  relieve  the  condition  and  aid  in  removing  some  of  the 
discoloration.  The  fomentation  may  be  repeated  every  three  hours, 
but  should  inflammation  set  up  the  compress  should  be  changed  every 
half  hour  and  the  method  of  fomentation  and  compress  used  every 
three  hours. 

In  diseases  of  the  eye  ball  of  a  painful  and  inflammatory  character 
nothing  is  more  satisfactory  in  their  management  than  the  application 
of  the  fomentation  at  130°  to  140°  F.  for  two  to  five  minutes,  re- 
peated three  or  four  times  and  followed  by  frequent  applications  of 
the  ice  compress  heretofore  described  in  detail  in  this  section.  This 
method  of  treatment  of  changing  the  compress  every  few  minutes 
and  repeating  the  fomentation  every  two  or  three  hours  will  bring 
about  revulsive  effects,  by  means  of  which  congestion  is  relieved  and 
pain  mitigated. 

In  asthenopia,  or  irritable  eye,  the  fomentation  at  130°  to  140°  F. 
for  five  minutes,  repeated  for  five  minutes,  followed  by  the  cold  com- 
press wrung  out  of  ice- water  for  one-half  minute,  repeated  several 
times,  will  oftentimes  relieve  this  most  disagreeable  and  painful 
symptom. 

In  the  earache  that  results  from  acute  inflammation  of  the  external 


DISEASES  OF  THE  SKIN,  EYE  AND  EAR.  579 

organ,  or  irritations  and  inflammations  located  in  the  external  audi- 
tory canal ;  in  acute  otitis  media,  irrigation  with  normal  saline  solu- 
tion at  100°  to  120°  F.,  followed  hy  the  compress  as  hot  as  can  be 
borne,  over  which  a  hot-water  bottle  or  Leiter's  tubes  are  placed,  with 
water  circulating  at  a  high  temperature,  will  nearly  always  give  relief 
and  comfort  to  the  patient. 

In  the  use  of  heat  and  cold  to  the  eye,  it  may  be  again  stated  that 
cold  relieves  pain,  checks  secretion,  is  germicidal  and  retards  pus 
formation,  while  exercising  an  intense  antiphlogistic  influence  upon 
these  structures.  Heat  relieves  pain,  promotes  reparative  cellular 
activity,  hastens  absorption  of  exudates,  is  germicidal,  and  increases 
the  local  action  of  drugs.  Heat  should  be  first  applied  and  the  medi- 
cine then  instilled.  After  prolonged  (two  to  three  hours)  cold  appli- 
cations, their  use  should  be  intermitted,  and  brief  hot  applications 
made,  in  order  that  neural  and  circulatory  activity,  numbed  and  ob- 
tunded  by  the  cold,  may  be  roused  to  activity  and  the  cycle  of  good 
effects  re-established. 

In  all  chronic  eye  and  ear  affections,  improvement  is  often  coin- 
cident with  the  improvement  of  general  health,  and  for  this  reason 
general  tonic  hydrotherapy  is  indicated,  in  which  the  electric  light 
bath,  rain,  shower,  douches,  etc.,  will  be  found  useful.  Sea  air  and 
sea  bathing  have  often  made  a  permanent  cure,  and  should  be  more 
frequently  recommended. 


CHAPTER  XXVI. 
HYDROTHERAPY  IN  SURGERY. 

Contusions. 

A  contusion  or  bruise  is  a  subcutaneous  laceration  of  the  tissue 
due  to  the  application  of  blunt  force,  without  the  skin  above  being 
injured,  damaged  or  a  surface  breach  occurring,  an  affusion  of  blood 
taking  place  in  the  tissue  injured.  Trauma  of  all  kinds — blows, 
kicks,  punches,  etc. — produce  the  injury.  The  effusion  of  blood  may- 
be large  or  small,  circumscribed  or  diffuse,  the  tissue  vitality  unim- 
paired or  seriously  devitalized ;  gangrene  may  result.  Suppuration 
rarely  occurs,  and  when  it  does  is  usually  in  a  drunkard  (see  Alco- 
holism). Arrest  of  hemorrhage  occurs  from  resistance  of  the  tissue, 
contraction  or  retraction  of  the  blood-vessels  and  coagulation.  The 
fluid  elements  of  the  blood  are  soon  absorbed,  the  red  corpuscles 
break  up,  set  free  their  pigment,  which  is  carried  from  the  seat  of 
injury.  The  pigment  may  crystallize  and  remain  in  the  tissues  as 
hematoidin,  staining  them  for  months,  sometimes  for  years.  As  the 
blood  is  absorbed  it  undergoes  chemical  changes,  and  the  tissues  may 
assume  a  red,  purple,  black,  green,  lemon  or  yellow  color.  This  is 
seen  typically  in  the  "black  eye."  There  is  localized  pain,  tenderness, 
swelling  and  some  numbness.  The  looser  the  tissue  the  greater  the 
swelling  and  the  deeper  the  discoloration.  Severe  contusion  of  vital 
structure  is  followed  by  considerable,  sometimes  grave,  even  fatal 
shock. 

The  first  thing  to  be  done  is  to  relieve  the  shock,  should 
it  be  present,  and  give  the  parts,  as  far  as  possible,  functional 
rest.  If  in  an  extremity,  this  should  be  elevated,  and  in  the  early 
stage  cold,  in  the  shape  of  a  compress  at  60°  to  50°  F.,  applied  and 
frequently  repeated.  If  much  shock  and  local  depression  of  the  vital- 
ity of  the  tissue  is  apparent,  heat  and  stimulation  are  indicated. 
Taking  the  vast  majority  of  contusions,  the  following  treatment  has, 
in  the  author's  experience,  proved  very  effective  in  promptly  relieving 
pain,  reducing  swelling,  favoring  absorption  and  preventing  too  great 
discoloration.  As  soon  as  possible  after  the  injury  apply  the  fomenta- 
tion at  130°  to  160°  F.,  or  as  hot  as  can  possibly  be  borne,  for  ten 
minutes,  and  repeat  for  ten  minutes.  This  is  followed  by  the  stimu- 
lating compress  at  60°  to  50°  F.,  which  is  allowed  to  remain  on  until 
the  next  application  of  the  fomentation,  which  in  the  early  stage 
should  be  every  hour,  the  time  being  lengthened  as  the  swelling,  pain, 
(580) 


HYDROTHERAPY  IN  SURGERY.  581 

etc.,  diminish.  Richter1  recommends  the  immersion  of  the  part  for 
one  hour  in  very  hot  water  (as  hot  as  can  be  borne),  made  alkaline 
with  natrium  bicarbonate,  stating  that  this  method  resembles  greatly 
Bier's  hyperemic  method,  but  is  much  simpler  and  can  be  applied 
anywhere. 

Sprains. 

A  sprain  is  a  joint-wrench  due  to  a  sudden  twist  or  traction,  the 
ligaments  being  pulled  upon  or  lacerated  and  the  surrounding  parts 
being  more  or  less  damaged.  The  knee,  elbow  and  ankle  are  the 
joints  most  frequently  involved.  In  a  bad  sprain  the  synovial  mem- 
brane is  contused  or  lacerated,  the  ligaments  torn,  the  cartilages 
loosened  or  separated,  muscles  or  tendons  stretched,  displaced  or 
lacerated,  vessels  and  nerves  damaged  and  the  skin  often  contused. 
Sprains  are  common  in  the  young  and  in  adults  with  weak  muscles. 
They  result  from  sudden  twists  or  wrenches  when  the  muscles  are 
relaxed,  the  muscles  being  caught,  as  it  were,  unawares.  A  joint 
once  sprained  is  liable  to  a  repetition  of  the  damage  from  slight  force. 
The  sprain  is  accompanied  by  pain  and  nausea,  sometimes  vomiting 
and  syncope.  Swelling,  restricted  movement,  pain  and  tenderness 
are  generally  present.  The  usual  time  required  for  recovery  (?)  is 
six  to  eight  weeks. 

For  the  first  few  days  where  wrench  has  been  very  severe, 
functional  rest  and  elevation  of  the  parts  must  be  secured.  Where 
these  conditions  are  treated  in  the  home,  the  application  of  the  local 
hot  bath  at  110°  to  120°  F.,  or  as  hot  as  can  possibly  be  borne,  or 
the  fomentation  at  140°  to  160°  F.  for  ten  minutes,  followed  by  the 
application  of  a  firm  and  snugly  fitting  flannel  bandage,  will  oftentimes 
give  relief  that  is  surprising.  The  author,  however,  has  firmly  settled 
convictions  regarding  the  treatment  of  sprain,  and  he  believes  that 
nothing  in  the  whole  domain  of  medicine  or  surgery  will  give  such 
satisfactory  results  as  the  application  of  the  local  superheated  dry 
hot-air  apparatus  at  temperatures  ranging  from  350°  to  400°  F.  for 
one  hour.  The  sprained  joint  should  be  properly  covered  with 
Turkish  toweling,  carefully  placed  in  the  local  hot-air  apparatus 
and  the  temperature  rapidly  raised  to  the  point  indicated.  Treatment 
may  be  given  once  or  twice  daily,  especially  if  the  injury  has  occurred 
in  a  person  whose  extremities  are  thick.  It  is  marvelous  to  see  the 
almost  instantaneous  relief  of  pain  that  this  high  temperature  brings 
about,  and  how  quickly  it  removes  the  exudates,  hastens  repair  and 
prevents  the  disability  that  would  come  from  confinement  to  the  chair 
or  house. 

In  the  very  recent  cases,  where  the  injury  is  not  severe  and  has 
only  existed  for  four  to  six  hours,  the  use  of  this  measure  once  or 

1  Munchener  Med.  Wochenschrift,  LIII,  No.   15. 


582  PRACTICAL  HYDROTHERAPY. 

twice  daily  will  frequently  enable  the  individual  to  be  practically  well 
in  forty-eight  hours.  In  other  cases,  after  two  or  three  days  have 
elapsed,  the  treatment  may  require  one  to  three  weeks  for  a  complete 
cure,  although  pain  is  promptly  and  satisfactorily  relieved  after  several 
applications.  In  each  instance  the  application  of  the  dry  hot  air  should 
be  followed  by  the  flannel  bandage,  snugly  and  firmly  applied. 

In  chronic  cases  that  have  failed  to  be  relieved,  and  whose  joint  is 
swollen,  it  will  be  almost  surely  cured  (?),  unless  organic  destruction 
has  taken  place,  by  the  following  satisfactory  method :  Local  super- 
heated dry  hot  air  at  400°  F.  for  one  hour,  followed  by  the  Scottish 
or  alternating  douche  applied  to  the  joint  at  a  temperature  of  105° 
to  120°  F.  for  one-fourth  to  one-half  minute,  pressure  thirty  pounds, 
alternated  with  a  temperature  of  60°  to  50°  F.  for  five  to  ten  seconds, 
four  to  six  alternations.  In  these  chronic  cases  we  frequently  find 
that  the  general  health  has  been  more  or  less  influenced  by  the  local 
injury  and  shock  sustained,  and  for  this  reason  it  is  an  excellent  plan 
to  administer  the  superheated  dry  hot-air  body  apparatus  two  to  three 
times  weekly  at  a  temperature  of  250°  to  300°  F.  for  one  hour,  fol- 
lowed by  the  horizontal  rain  bath  at  75°  F.  for  one- fourth  minute. 
It  should  be  noted  that  in  this  application  no  warm  water  is  used  in 
the  rain  bath.  It  will  be  found  that  after  the  application  of  the  super- 
heated dry  hot  air  to  the  joint,  massage,  flexion  and  manipulation 
will  materially  aid  in  restoring  function  and  activity  to  the  parts. 
Some  authors  suggest  that  the  hydriatic  treatment  should  be  followed 
by  an  oil  rub  and  friction  to  the  affected  joint,  but  the  author  has 
never  seen  any  special  advantage  derived  from  the  use  of  unguents, 
the  benefit  derived  being  due  to  the  massage  and  manipulations. 

Dislocations. 

A  dislocation  is  the  persistent  separation  from  each  other,  par- 
tially or  completely,  of  two  articular  surfaces.  Dislocations  may  be 
traumatic,  spontaneous  or  pathologic  and  congenital.  They  may  be 
complete,  partial,  simple,  compound  or  complicated.  They  are  most 
common  in  the  middle-aged,  in  males,  in  those  who  are  engaged  in 
severe  muscular  work,  and  in  those  joints  that  are  ball  and  socket. 
External  violence  and  muscular  action  are  the  most  frequent  causes. 
Pain,  rigidity,  deformity  and  change  of  bony  relations  are  present. 

The  ideal  method  of  setting  a  dislocation,  of  course,  is  the 
use  of  an  anesthetic,  by  means  of  which  complete  relaxation  of  the 
parts  is  secured,  pain  and  suffering  avoided.  In  some  cases,  where 
cardiac  disease  is  present,  where  the  surgeon  is  unable  to  secure 
an  anesthetic  or  where  same  is  refused,  we  can  frequently  secure 
better  results  in  replacements  by  first  applying  to  the  joint  the  fo- 
mentation at  130°  to  160°  F.  for  five  minutes,  repeated  for  five  min- 
utes ;   or  we  may  place  the  patient  in  a  full  hot  bath  at  a  temperature 


HYDROTHERAPY  IN  SURGERY.  583 

of  105°  to  110°  F.  for  five  to  ten  minutes,  at  the  end  of  which  time  in 
every  case  we  may  expect  relaxation  of  the  muscular  tension  at  the 
joint  that  will  permit  of  more  satisfactory  restoration  of  the  dislo- 
cation. Where  much  injury  has  been  done,  and  the  part  is  very 
painful,  it  is  a  good  plan  to  first  secure  rest  of  the  part;  apply  thereon 
the  ice-bag,  which  will  assist  in  preventing  inflammation,  swelling, 
etc.  If  pain  is  present  in  a  marked  degree  after  functional  restora- 
tion, the  fomentation  at  130°  to  160°  F.  for  ten  minutes,  repeated 
for  ten  minutes,  followed  by  the  stimulating  compress  at  50°  to  40° 
F.  for  one-half  to  one  hour,  will,  in  a  very  short  while,  give  relief  to 
suffering.     This  treatment  may  be  repeated,  three  to  four  times  daily. 

Fractures. 

A  fracture  is  the  solution  of  continuity  of  a  bone  or  cartilage  by 
the  application  of  sudden  force.  They  may  be  simple,  compound, 
comminuted,  complicated,  linear,  green-stick,  depressed,  impacted,  etc. 

Bones  are  predisposed  to  fracture  according  to  their  shape,  struc- 
ture and  position ;  by  spinal  or  trophic  diseases  ;  by  rickets,  osteo- 
malacia, etc.  External  violence,  direct  or  indirect,  is  the  usual  ex- 
citing factor.  Pain,  deformity,  loss  of  function  of  the  part,  motility 
and  crepitus  are  usually  present.  Repair  takes  place  in  from  four  to 
six  weeks. 

As  a  rule,  hydrotherapy  can  be  of  little  service  in  the  treat- 
ment of  ordinary  fracture,  although  the  fomentation  at  130°  to 
160°  F.,  applied  for  ten  minutes,  will  assist  in  relieving  pain,  relaxing 
muscular  tension  and  stimulate  vitality  before  applying  the  per- 
manent dressing.  In  compound  inoperable  fractures  nothing  is 
equal  to  the  use  of  the  local  continuous  neutral  immersion  bath  at  a 
temperature  of  94°  to  92°  F.  This  bath  will  allay  inflammation,  relieve 
pain,  prevent  sepsis  and  favor  healing.  It  is  the  method  par  ex- 
cellence. 

Spinal  Curvature. 

This  condition  may  present  variations  from  the  normal,  anteriorly, 
posteriorly  or  laterally.  It  results  usually  from  weak  muscles  and 
ligaments,  by  habitual  assumption  of  unnatural  and  strained  attitudes. 
It  occurs  most  frequently  in  young  girls  at  the  age  of  puberty,  when 
the  bones  are  weak  and  the  muscles  soft.  The  weak  muscles  cease 
to  sustain  the  spinal  column  and  the  ligaments  stretch,  relax  or 
lengthen.  Stooping  is  noticed ;  there  is  a  weakness  in  the  back,  after 
a  time  pain ;  walking  may  be  awkward  and  ungraceful ;  deformity  is 
present ;  tenderness  on  pressure ;  the  abdomen  is  protuberant  and 
the  chest  flattened. 

The  important  object  in  this  disease  is  to  restore  muscular 
nutrition  and  overcome  the  deformity.  To  this  end  we  pre- 
scribe proper  clothing,  free  all  constriction,  avoid  corsets,  and  instruct 


584  PRACTICAL  HYDROTHERAPY. 

the  patient  in  gymnastics  and  deep  breathing.  Electricity  and  mas- 
sage to  the  muscles  involved  are  especially  valuable.  The  patient 
must  study  improved  methods  in  sitting  and  standing.  Exercise  should 
be  insisted  upon,  of  which  golf,  rowing,  swimming  and  walking  are 
valuable.  In  the  general  upbuilding  of  the  system  nothing  is  better 
than  hydrotherapy,  as  it  increases  the  muscular  tone  and  circulation, 
energizes  muscular  tissues  to  action  and  develops  their  strength.  These 
individuals  are,  as  a  rule,  weak,  nervous  and  irritable,  and  for  that 
reason  we  should  commence  cautiously  to  develop  their  reactive  ca- 
pacity. At  the  start  the  cold  sponge  once  daily  at  85°  F.,  followed  by 
friction  with  a  crash  towel.  Reduce  the  temperature  two  degrees 
daily  to  75°  F.,  at  which  time  substitute  for  the  sponge  the  dripping 
sheet  at  75°  F.  for  three  minutes,  likewise  followed  by  vigorous  fric- 
tion and  reaction;  reduce  the  temperature  two  degrees  daily  to  60° 
F.,  at  which  point  we  may  institute  for  a  few  days  the  following: 
Electric  light  bath  just  to  the  point  of  perspiration,  followed  by  the 
half  bath  with  friction  to  the  parts  immersed  for  one  to  two  minutes, 
concluding  the  treatment  with  an  affusion  to  the  back  and  chest  at 
60°  F.  Now  proceed  to  the  following :  Electric  light  bath  to  the  point 
of  perspiration,  followed  by  the  horizontal  rain  bath  at  100°  to  102° 
F.  for  one  minute,  pressure  thirty  pounds,  followed  by  the  jet  douche 
to  the  spine  and  the  fan  douche  to  the  body  and  abdomen  at  60°  F., 
pressure  thirty  pounds,  for  ten  seconds  each.  As  soon  as  the  patient 
is  able,  give  the  following:  Electric  light  bath  to  perspiration,  fol- 
lowed by  the  Scottish  or  alternate  jet  douche  to  the  spine  and  fan 
douche  to  the  body  for  one-fourth  to  one-half  minute  at  102°  to  105° 
F.,  first  to  the  spine  and  then  to  the  body,  alternating  in  the  same 
manner  with  a  temperature  of  60°  F.  for  five  to  ten  seconds,  pressure 
thirty  pounds.  It  is  really  at  times  astounding  to  note  the  changes 
that  take  place,  not  alone  in  the  general  health,  but  in  the  muscular 
structures  of  the  body  other  than  spinal,  under  the  use  of  this  power- 
ful thermic  and  percutient  measure.  To  those  who  have  never  ex- 
perienced the  stimulating  and  exhilarating  influence  of  the  jet  douche 
to  the  spinal  column,  such  effects  come  as  a  revelation. 

Angular  Curvature  of  the  Spine;  Pott's  Disease;  Spondylitis;  Caries. 

These  conditions  are  usually  due  to  tuberculosis,  and  occur  most 
frequently  in  children  who  are  predisposed  to  the  disease.  The  dorso- 
lumbar  region  is  most  prone  to  suffer.  The  body  of  the  vertebrae  and 
the  vertebral  disks  are  destroyed ;  the  weight  of  the  spinal  column 
resting  on  the  softened  bone  causes  it  to  crumble,  compresses  the  dis- 
eased vertebrae,  and  angular  deformity  results.  Caseation,  pus  forma- 
tion or  inflammatory  organization  may  take  place.  In  some  cases  the 
cord  is  compressed,  either  by  the  bone  or  by  the  inflammatory  deposits. 

Rest,     immobility,    nutritious    diet    and    sea    air    are    prominent 


HYDROTHERAPY  IN  SURGERY.  585 

indications  in  these  cases.  Surgical  measures  should  he  at  once 
instituted,  hy  means  of  which  the  spinal  column  is  straightened  and 
functional  rest  given  to  the  parts,  preferably  by  fixation  and  the  re- 
clining position.  A  nutritious  diet,  in  which  the  fats  form  an  impor- 
tant element,  is  essential ;  tonics  are  indicated.  The  recent  results 
obtained  by  treating  bone  tuberculosis  at  the  sea-shore  have  shown 
that  sea  air  is  better  than  country  or  mountain  atmospheres.  Where 
this  cannot  be  carried  out,  use  surgical  measures,  and  in  addition  the 
cold  sponge  at  90°  F.,  reduced  two  degrees  daily  to  60°  F.,  once  or 
twice  during  the  twenty-four  hours.  After  the  active  process  has 
subsided  and  the  case  enters  the  chronic  stage,  all  those  measures  that 
have  heretofore  been  noted  under  the  head  of  tuberculosis  should  be 
instituted  and  the  treatment  persistently  carried  out.  These  embrace 
the  dripping  sheet,  the  electric  light  bath,  the  horizontal  rain  bath  and 
the  gentle  jet  douche  to  the  spine. 

Surgical  Shock. 

Shock  is  the  sudden  depression  of  the  vital  powers  arising  from 
injury,  operation  or  profound  emotion  acting  on  the  nervous  system 
and  inducing  exhaustion  or  inhibition  of  the  vasomotor  mechanism. 
Blood  pressure  is  lowered,  cardiac  action  weakened,  respiration  im- 
peded, with  either  collapse  or  a  tendency  to  same.  Death  results 
from  reflex  inhibition  of  the  pneumogastric  nuclei  and  arrest  of  car- 
diac action.  It  occurs  more  frequently  in  women,  in  those  who  are 
weakened  by  suffering,  in  those  who  are  fearful,  in  those  who  have 
diseases  of  the  kidney,  liver  or  heart,  and  who  are  alcoholics.  Injuries 
to  the  spine,  brain,  nerves,  testicles,  thoracic  and  abdominal  viscera 
produce  extreme  shock.  Railway  accidents,  with  their  physical  and 
psychic  shock,  are  especially  weakening.  Chilling  during  an  operation 
favors  shock.  Sudden  and  profuse  hemorrhage,  too  rapid  removal  of 
the  fluids  from  cavities,  resulting  in  a  sudden  lessening  of  internal 
pressure  by  too  rapid  filling  of  the  intra-abdominal  veins,  may  cause 
it.  The  pulse  is  small,  weak,  compressible ;  temperature  subnormal ; 
skin  cold,  clammy  and  sweating;  respiration  shallow  and  irregular; 
mentality  lessened ;  pupils  dilated  and  sphincters  relaxed. 

Every  effort  should  be  made  to  stimulate  the  vitality,  and 
to  this  end  the  patient  is  wrapped  in  blankets,  heat  applied  by 
means  of  hot-water  bottles,  and  if  the  case  is  severe  a  hot  enema  of 
normal  saline  solution  or  hypodermoclysis  (500  to  1,000  c.c),  or 
both  given.  Lower  the  head  of  the  bed  and  place  an  ice-bag  to  the 
heart  over  compress.  The  ice-bag  must  be  removed  at  the  end  of 
twenty  minutes,  a  fomentation  applied  at  130°  to  140°  F.  for  one  or 
two  minutes,  and  then  replaced.  Sometimes  fomentations  to  the 
spine  at  130°  to  160°  F.,  repeated  every  few  minutes,  will  stimulate 
and   arouse   the   nerve  centers.      Some   authors   state   that   abdominal 


586  PRACTICAL  HYDROTHERAPY. 

massage,  by  preventing  the  accumulation  of  blood  in  the  viscera,  will 
materially  aid  in  restoring  the  circulation  and  overcoming  the  de- 
pression. Crile  has  found  adrenalin  chloride  to  be  valuable.  Nothing 
takes  the  place  of  the  superheated  dry  hot-air  body  apparatus  for  the 
application  of  heat  to  the  body  surfaces,  and  this  measure  should  and 
ought  to  be  at  hand  in  a  surgical  infirmary  and  operating-room,  for 
the  vitalizing  effects  of  this  application  will  more  quickly,  surely  and 
certainly  overcome  the  shock  and  depression  than  anything  that  the 
author  knows,  although  his  experence  in  this  line  has  been  extremely 
limited,  though  none  the  less  gratifying.  As  soon  as  reaction  takes 
place  we  should  institute  the  sponge  at  60°  to  50°  F..  using  a  crash 
rag,  taking  especial  care  to  have  the  room  warm,  exposing  only  one 
part  of  the  body  at  a  time,  applying  considerable  friction  during  the 
cold  application  and  rubbing  the  part  afterward  until  thoroughly  dry, 
red  and  warm.  The  ice-bag  may  be  repeated  every  hour  or  oftener; 
the  sponge  every  two  or  three  hours.  The  method  of  sponging  will 
have  to  be  modified  to  suit  the  particular  cause  of  the  shock. 

Hemorrhage. 

Hemorrhage,  or  loss  of  blood,  may  arise  from  arteries,  veins,  cap- 
illaries, or  from  the  three  combined.  It  may  be  internal  or  external. 
Loss  of  half  of  the  blood,  four  to  six  pounds,  will  usually  cause  death ; 
women  stand  a  larger  loss  than  men.  Old  people,  the  very  young, 
drunkards,  and  those  suffering  from  nephritis,  diabetes  and  sepsis, 
stand  the  loss  of  blood  poorly.  After  much  bleeding  syncope  occurs, 
Nature's  effort  by  means  of  weak  and  feeble  circulation  to  allow  the 
formation  of  a  clot.  Vertigo,  dimness  of  vision,  roaring  in  the  ears, 
great  thirst,  dilated,  slowly-reacting  pupils,  shallow  respiration,  cold, 
clammy  perspiration,  subnormal  temperature,  muscular  weakness  and 
tremor  usually  occur. 

The  location  of  the  hemorrhage  will  modify  the  method  of 
treatment,  as  to  whether  it  will  be  compression  or  ligation.  Here 
again  the  use  of  heat  in  the  shape  of  a  dry  hot  blanket,  together 
with  the  administration  of  the  hot  enema  of  normal  saline  solution, 
hypodermoclysis  of  normal  saline  and  adrenalin  chloride  are  indi- 
cated. Where  the  pulse  is  very  strong  and  very  active  the  hot  water 
bag  applied  over  the  heart  will  reduce  its  force.  Capillary  oozing 
may  be  controlled  by  the  very  hot  compress  at  130°  to  160°  F.,  fre- 
quently repeated,  for  three  to  four  minutes  at  the  most.  In  order  to 
control  the  hemorrhage  by  means  of  cold,  we  may  use  the  cold  com- 
press, frequently  repeated,  or  the  compress  over  which  is  placed  a  coil 
of  Leiter's  tubes.  Cold  has  a  tendency  to  devitalize  the  tissues  after 
hemorrhage  when  used  in  this  manner.  When  reaction  takes  place 
cold  should  be  applied  to  the  head  in  the  shape  of  a  compress  over 
which  the  ice-cap  is  placed.     The  fever  that  follows  must  be  treated 


HYDROTHERAPY  IN  SURGERY.  587 

as  elsewhere  indicated.  Free  drinking  of  ice-water,  eating  of  small 
pieces  of  ice  and  the  application  of  the  cold  sponge  at  60°  F.,  one  to 
three  times  daily,  will  be  found  an  efficient  measure  to  control  the 
condition. 

Surgical  Fever. 

Genuine  or  true  surgical  fever  is  seen  as  the  result  of  infected 
wounds  where  there  is  decided  inflammation  but  no  pus.  This  fever 
is  caused  by  the  presence  of  fermentative  bacteria  in  the  wound  and 
the  absorption  of  their  toxic  products,  most  commonly  bacteria  of 
a  putrefactive  type.  Drainage  relieves  the  fever,  as  a  rule.  There  is 
chill,  fever  (101°  to  103°  F.),  thirst,  anorexia,  nausea,  coated  tongue, 
constipation,  scanty  and  high-colored  urine.  The  wound  is  painful, 
tender,  swollen,  discolored  and  often  foul.  Pus  may  form,  in  which 
event  the  fever  is  due  to  the  absorption  of  the  toxins  of  pyogenic 
bacteria.  Suppuration  is  prevented  by  the  maintenance  of  nutrition, 
personal  cleanliness,  asepsis  and  antisepsis  in  surgical  work. 

The  treatment  to  be  instituted  should  not  deter  the  surgeon 
from  interfering  surgically  with  the  conditions  present.  Give  sut- 
ficient  quantities  of  saline  laxatives  to  produce  purgation,  accom- 
panied by  free  water-drinking  to  promote  diuresis.  The  diet  must  be 
liquid  and  cold.  To  the  parts  involved  the  application  of  the  cooling 
compress  or  the  compress  over  which  the  ice-bag  is  placed,  while  at 
the  same  time  a  general  cold  sponge  is  administered,  will  frequently 
enable  the  patient  to  throw  off  the  systemic  and  overcome  the  local 
effects.  Where  the  case  demands,  hypodermoclysis  of  normal  saline 
solution  should  be  used.  For  weak  heart  use  the  compress  and  ice- 
bag  to  the  precordium,  interrupted  every  two  or  three  hours  by  the 
fomentation  for  two  to  three  minutes.  Where  it  is  desirable  at  any 
time  to  favor  suppuration,  the  use  of  the  fomentation  every  three 
hours  at  130°  to  160°  F.  for  ten  minutes,  repeated  for  ten  minutes 
and  followed  by  the  stimulating  compress,  will  bring  about  the  desired 
result.  Kellogg  recommends  the  use  of  the  fomentation  and  the  ice- 
cold  compress  alternately.  They  should  be  used  continuously,  com- 
mencing with  the  hot  and  always  ending  with  the  cold  application. 
Nothing  equals  the  action  of  the  superheated  dry  hot-air  local  appa- 
ratus applied  to  the  part  involved.  The  action  of  this  measure  is  to 
inhibit  and  destroy  germ  life ;  it  neutralizes  and  consumes  the  toxins 
already  formed,  and  prevents  their  formation ;  it  enhances  the  vital 
and  resistive  power  of  the  affected  tissue,  the  line  of  demarcation 
being  more  quickly  established ;  it  favors  destruction  and  throwing 
off  of  the  dead  and  devitalized  tissue ;  it  increases  granulation  and 
healing,  enhances  circulation  and  repair  of  tissue  by  the  blood  stream, 
relieves  pain  and  promotes  comfort.  In  a  recent  case  of  this  character 
the  author  has  had  the  pleasure  of  seeing  the  disease  almost  immedi- 
ately stop  and  improvement  take  place  within  twenty- four  hours. 


588  PRACTICAL  HYDROTHERAPY. 

Abdominal  Surgery. 

In  those  cases  of  abdominal  section  in  which  the  necessity  to  op- 
erate is  not  urgent  or  imperative,  the  individual  can  be  prepared  and 
the  vital,  resistance  and  power  greatly  enhanced  by  a  general  prepar- 
atory course  in  hydrotherapy.  The  measures  hereinafter  recom- 
mended, combined  with  suitable  hygiene,  diet  and  ordinary  surgical 
preparation  will  so  enormously  increase  the  patient's  power  of  re- 
sistance that  many  cases  would  sustain  the  operation  more  satisfac- 
torily, recovering  more  promptly  with  fewer  complications.  The  vast 
majority  of  these  cases  have  had  their  general  health  and  tone  under- 
mined by  the  toxic  influences  that  are  usually  associated  with  their 
disease,  their  neural  power  weakened  by  pain,  loss  of  rest  and  other 
nerve-racking  conditions,  so  that  they  present  a  picture  too  familiar  to 
all  practitioners  to  go  further  into  details.  By  its  action  hydrotherapy 
opens  up  the  secretory  structures  of  the  skin  and  kidney,  increases  the 
activity  of  the  heart  and  circulation,  perfects  oxidative  processes,  and 
by  its  powerful  energizing  influences  upon  the  sympathetic  and  cen- 
tral nervous  systems,  betters  digestion,  increases  absorption,  over- 
comes toxemia  and  infuses  a  sense  of  well-being  and  strength.  This 
is  of  advantage,  as  it  robs  the  patient  of  the  inherent  terror  of  the 
anesthetic  and  the  psychic  depression  that  always  accompanies  major 
operations.  The  method  should  be  employed  for  ten  days  or  two 
weeks  prior  to  the  operation. 

Start  with  the  cold  sponge  in  the  morning,  at  mid-day  and  in  the 
evening;  commence  with  a  temperature  of  80°  F.,  and  reduce  five  de- 
grees each  application  until  50°  F.  is  reached,  at  the  same  time  keeping 
the  bowels  open,  having  the  patient  drink  freely  of  water,  using  the 
hot  saline  enema  once  daily  and  the  vaginal  douche  when  indicated 
twice  daily.  Xo  meats  or  meat  extracts  should  be  allowed  during  this 
period.  On  the  third  day  we  may  begin  with  the  dripping  sheet  in  the 
morning  and  evenings  at  60°  F.  for  three  minutes,  accompanied  by 
vigorous  friction,  while  the  patient  stands  in  a  hot  foot-bath,  as  hot 
as  can  be  comfortably  borne.  Where  the  patient  is  up  and  able  to  go 
about  we  may  then,  at  the  end  of  two  days  of  this  treatment,  institute 
the  electric  light  bath  or  the  hot-air  bath  to  the  point  of  profuse  per- 
spiration, or  the  superheated  dry  hot  air  body  apparatus  for  thirty  to 
sixty  minutes  at  250°  to  300°  F.,  or  the  full  wet  pack  at  65°  F.  for 
one  hour,  followed  by  the  horizontal  rain  bath  at  100°  F.  for  one  to 
two  minutes,  reduced  to  60°  F.  for  one-fourth  minute,  pressure  thirty 
pounds.  Where  the  patient  is  confined  to  bed  the  use  of  the  cold 
sponge  in  the  morning,  at  mid-day  and  the  trunk  compress  or  the  half 
wet  pack  at  65°  F.  in  the  evening,  will  be  found  an  excellent  method. 
Where  certain  parts  are  painful  the  fomentation  at  130°  to  160°  F. 
may  be  administered  once  or  twice  daily,  followed  by  the  hot-water 


HYDROTHERAPY  IN  SURGERY.  589 

bag  to  the  parts   so  treated.       Tonics  should  be  given  and  opiates 
avoided. 

During  the  anesthetic  the  heart  may  be  energized  by  the  use  of  the 
ice-bag  applied  to  the  precordium,  this  simple  measure  rendering,  as 
the  author  has  seen,  valuable  service  in  combating  threatened  cardiac 
weakness  and  failure.  Many  cases  are  benefited  by  hypodermoclysis 
of  500  to  1,000  c.c.  of  normal  saline  solution,  the  action  being  to  re- 
move the  effects  of  the  anesthetic,  fill  the  blood-vessels,  increase  heart 
action  and  favor  elimination,  thus  combating  shock  and  collapse. 
Succeeding  the  removal  of  the  anesthetic,  if  the  pulse  is  bad,  apply 
the  ice-bag  to  the  precordium  for  fifteen  to  twenty  minutes  every  two 
hours,  preceding  it  by  a  brief  application  of  the  fomentation.  Repeat 
every  one,  three  or  four  hours  as  needed.  Vomiting  may  be  relieved 
by  lavage  unless  contraindicated,  or  the  ice-bag  applied  to  the  epigas- 
trium or  spine  opposite.  The  swallowing  of  small  pieces  of  ice,  a 
warm  enema  at  96°  to  98°  F.  to  favor  elimination  and  kidney  action, 
may  always  be  used.  Denuce2  gives  his  patients  some  water  just 
prior  to  operation,  having  found  that  patients  swallow  air.  mucus  and 
saliva  charged  with  chloroform,  which  irritates  the  mucous  membrane 
of  the  viscus  and  causes  it  to  empty  itself.  The  water  prevents  the 
vapor  reaching  the  walls  of  the  stomach.  One  and  a  half  hours  before 
the  operation  a  "large"  glass  of  water  is  given  and  repeated  every 
half  hour  to  time  of  operation,  four  glasses  in  all.  amounting  to  about 
1,000  c.c.  This  is  especially  valuable  in  surgical  cases  complicated  by 
gastric  disease,  in  which  tenacious  mucus  is  present  in  the  stomach, 
and  in  whom  vomiting  may  persist  for  clays.  Lavage  before  and  at 
the  termination  of  the  operation,  together  with  the  use  of  the  water 
as  above  mentioned,  has  given  "excellent  results."  During  the  first 
few  hours  succeeding  the  operation  no  hydriatic  measures  should  be 
instituted,  but  as  soon  as  practicable  we  commence  their  use,  for  we 
can  by  this  measure  hasten  the  progress  of  convalescence.  Nothing 
is  superior  to  the  cold  sponge,  accompanied  by  gentle  friction,  applied 
two  or  three  times  daily. 

Synovitis,  Acute  and  Chronic;  Arthritis;  Exudates  in  Joints;  Adhe- 
sions of  Joints;  Contractures  of  the  Joints. 

Synovitis,  is  a  primary  inflammation  of  the  synovial  membrane 
alone.  Where  other  structures  than  the  synovial  membrane  are  in- 
volved the  condition  is  then  known  as  "arthritis,"  for  the  treatment 
of  which  the  reader  is  referred  to  another  section.  The  acute  form 
usually  results  from  overuse,  twists,  sprains,  contusions,  gonorrhea, 
rheumatism,  tuberculosis,  and  some  believe  from  cold  and  damp.  The 
synovial  membrane  is  red.  swollen,  and  the  joint  contains  an  excess 
of  turbid,  fibrinous  material.     Secondarily,  arthritis  may  be  produced. 

2  Gazette  Hebdomidaire  des  Science  Medicales  de  Bordeaux,   1906. 


590  PRACTICAL  HYDROTHERAPY. 

Pain  in  the  joint,  increased  by  pressure,  movement  and  dependent 
positions;  swelling,  bulging,  fever,  and,  if  pus  forms,  rigors,  septic 
temperature  and  local  evidences  of  its  formation.  The  knee  is  most 
commonly  affected. 

The  usual  method  is  rest  and  immobilization  of  the  joint, 
and  where  it  is  indicated  aspiration  of  any  fluid  that  may  be 
present.  By  far  the  best  method  of  treating  these  cases  is  to  immedi- 
ately commence  with  the  use  of  the  superheated  dry  hot  air  local 
apparatus  at  300°  to  400°  F.  for  one  hour,  its  action  being  to  relieve 
pain,  hasten  recovery  and  prevent  ankylosis.  It  is  common  after  the 
first  treatment  or  two  for  the  joint  affected  to  feel  worse  for  a  few 
hours,  a  condition  brought  about  by  the  unusual  activity  of  the  joint, 
circulation.  Where  the  condition  is  tubercular  the  use  of  this  method 
is  not  contraindicated,  but,  on  the  contrary,  the  joint  will,  after  a 
while,  yield  to  the  treatment ;  but  should  this  fail  and  an  operation 
become  necessary,  the  individual  stands  a  better  chance  of  having  the 
disease  localized,  and  in  this  way  making  it  easier  for  the  surgeon  to 
remove  the  focus  of  the  infection.  The  author's  experience  has  been, 
that  the  cooling  compress  at  70°  to  60°  F.,  or  the  compress  covered 
by  the  ice-bag  to  the  parts  affected,  will,  in  the  early  stage,  when  the 
joint  is  swollen,  hot  and  tender,  prove  effective  in  further  relieving 
pain  and  stimulating  recovery.  If,  however,  suppuration  has  already 
started,  the  superheated  dry  hot  air  should  be  followed  by  the  use  of 
the  stimulating  compress  at  65°  F.,  or  alternating  compresses,  hot 
and  cold. 

Chronic  synovitis  usually  follows  the  acute,  but  may  be  chronic 
from  the  start.  Many  are  in  reality  tuberculous.  The  joint  may  be- 
come swollen  or  dropsical — "hydrops  articuli."  The  synovial  mem- 
brane is  much  thickened  and  adherent  in  some  places.  Pain  is  present 
only  on  use  or  pressure ;  passive  motion  may  develop  crepitus ;  fluctu- 
ation is  apparent  and  hypodermic  needle  aspiration  will  remove  a 
viscid,  straw-colored  fluid. 

In  these  old  chronic  joint  diseases  the  author's  experience  has 
been  considerable,  and  nothing,  in  his  opinion,  has  yielded  such 
excellent  results  as  the  superheated  dry  hot  air  local  apparatus 
at  a  temperature  of  300°  to  400°  F.  for  one  hour,  treatment  daily. 
Some  authors  recommend  the  local  electric  light  bath,  which  is  bene- 
ficial, but  possesses  nothing  like  the  power  of  the  above  method.  Some 
advantage  is  to  be  obtained  from  the  application  at  night  of  the  stim- 
ulating compress  at  60°  to  50°  F.,  well  protected,  and  the  firm  pressure 
that  can  be  obtained  from  a  tightly  fitting  bandage.  Hutchinson3  has 
used  with  satisfaction  a  stimulating  compress,  or  "salt  pack,"  applied 
as  follows :  A  piece  of  flannel  adapted  to  the  part  is  soaked  in  brine  or 
saturated  solution  of  salt  and  water  (at  50°  F.).  wrapped  around  the 

3   Hutchinson,  Jonathan,   Polyclinic,   1902. 


HYDROTHERAPY  IN  SURGERY.  591 

joint,  covered  with  another  piece  of  flannel,  over  which  oil  silk  is 
bound  by  a  roller  bandage.  The  author  can  recommend  this  simple 
but  useful  method. 

As  progress  is  made  and  the  condition  justifies  its  use,  we  may 
have  recourse  to  the  Scottish  or  alternating  jet  douche  to  the  joint  at 
110°  to  120°  F.  for  one- fourth  to  one-half  minute,  alternating  with  a 
temperature  of  65°  to  50°  F.  for  five,  ten  or  fifteen  seconds,  four 
alternations,  finishing  the  treatment  with  the  fan  douche  to  the  entire 
body  at  the  lower  temperature.  The  use  of  the  superheated  dry  hot 
air  and  the  Scottish  douche  has,  in  the  author's  experience,  proven 
especially  valuable  in  old  joint  troubles  accompanied  by  exudation  of 
any  kind. 

In  addition,  we  may  employ  electricity  to  the  joint,  massage  and 
passive  motion,  these  being  most  effectively  used  immediately  after 
the  application  of  hot  air.  It  is,  of  course,  understood  that  surgical 
methods  are  to  be  coincidental  with  these  treatments.  Tuberculous 
joints  are  best  treated  both  by  the  surgeon  and  the  hydriatist  rather 
than  by  either  of  them  alone. 

Ankylosis. 

When  a  joint  has  been  inflamed  and  the  inflammation  eventuates 
in  the  formation  of  new  tissue  in  and  about  the  joint,  contraction  of 
this  tissue  limits  or  destroys  the  mobility  of  the  joint,  producing  the 
condition  known  as  ankylosis,  which  may  be  either  complete  (bony) 
or  incomplete  (fibrous).  It  may  be  due  to  contraction  of  the  struc- 
tures of  the  joint  itself  or  from  contractures  in  the  structures  external 
to  the  joint.  Any  form  of  inflammation  by  which  new  tissue  may  be 
formed  will  produce  the  condition,  be  this  wounds,  contusions,  sprains, 
dislocations,  fractures,  tubercle,  gout,  rheumatism  or  syphilis.  Pro- 
longed immobilization  of  a  healthy  joint  will  produce  ankylosis  with 
muscular  atrophy,  weakness,  etc.  It  occurs  more  frequently  in  a 
hinge  than  ball  and  socket  joint.  Fibrous  ankylosis,  as  a  rule,  follows 
aseptic  inflammation;  the  bony,  infections. 

There  is  no  question  but  what  the  application  of  superheated 
dry  hot  air  in  those  diseases  that  cause  ankylosis  of  the  joints, 
by  removing  the  exudate  before  it  becomes  organized  and  by 
limiting  inflammation,  would,  as  a  rule,  limit  inflammation,  lessen  the 
deposit  of  lymph  and  prevent  ankylosis.  It  is,  therefore,  the  remedy 
par  excellence  as  a  preventative  of  this  condition,  and  at  the  same 
time  is  the  best  method  by  means  of  which  the  exudate  binding  down 
the  joint  may  be  softened  and  finally  removed,  save  in  those  cases 
where  bony  ankylosis  has  taken  place.  In  these  chronic  cases  nothing 
equals  the  combination  of  the  superheated  dry  hot  air  local  apparatus 
at  350°  to  400°  F.  for  one  hour,  followed  by  gentle  passive  motion 
for  a   few  minutes,  applying  immediately  thereafter  the   Scottish  or 


592  PRACTICAL  HYDROTHERAPY. 

alternating  douche  at  110°  to  120°  F.,  or  hotter  if  possible,  for  one- 
fourth  to  one-half  minute,  alternating  with  a  temperature  of  60°  to 
50°  F.  for  ten  to  fifteen  seconds,  four  to  six  alternations,  and  termin- 
ating with  the  general  fan  douche  at  a  temperature  of  60°  F.  to  the 
entire  body  for  five  to  ten  seconds.  In  some  cases,  where  the  general 
health  is  involved,  it  will  be  found  valuable  to  twice  weekly  substitute 
for  the  local  the  body  apparatus,  following  it  with  the  Scottish  douche 
to  the  joint  and  the  fan  douche  to  the  body  as  above  described. 

Ulcer. 

An  ulcer  is  a  solution  of  the  continuity  of  a  superficial  tissue,  due 
to  a  loss  of  substance  through  molecular  death.  It  is  brought  about 
by  the  action  of  micro-organisms,  usually  of  the  pus  group,  and  bears 
a  close  analogy  to  an  abscess.  The  floor  of  the  ulcer  is  usually  granula- 
tion tissue.  It  increases  in  size  by  molecular  death  of  surrounding 
tissue;  it  heals  by  granulation,  this  being  gradually  converted  into 
fibrous  tissue,  which,  contracting,  lessens  the  size  of  the  cavity.  When 
the  granulations  reach  the  level  of  the  skin,  the  epithelium  at  the 
edges  proliferate  and  cover  the  sore.  It  may  result  from  inflammation, 
septic  infection  (bacterial),  putrefactive  bacteria  in  wounds,  deficient 
blood  supply,  prolonged  pressure,  trauma,  interference  with  the  blood 
supply  to  or  its  return  from  a  tissue,  trophic  disturbances,  etc.,  but 
most  commonly  from  pus  organisms.  Ulcers  are  acme  or  chronic. 
Their  most  common  position  is  upon  the  leg. 

In  the  management  of  chronic  ulcer  the  first  thing  to  be 
done  is  to  administer  a  dose  of  calomel,  followed  by  a  saline,  and 
direct  the  patient  to  avoid  the  use  of  meats  and  alcohol  in  any  of  its 
forms.  The  ulcer  should  then  be  cleaned  thoroughly  with  peroxide 
of  hydrogen,  its  edges  clipped  away  and  the  surface  sterilized  with 
bichloride  of  mercury  solution  (1:1,000).  The  extremity  is  then 
placed  in  the  superheated  dry  hot  air  local  apparatus  at  250°  to  300° 
F.  for  one  hour,  followed  by  the  application  of  the  stimulating  com- 
press at  60°  F.,  over  which  a  firm  bandage  is  applied  every  day,  to 
or  above  the  knee  joint,  with  the  idea  of  supporting  the  circulation. 
Some  authors  speak  very  highly  of  the  local  electric  light  bath,  but 
the  author  has  found  the  preceding  method  so  satisfactory  that  he  has 
not  in  recent  years  deviated  from  its  use  in  the  management  of  this 
disagreeable  disease.  These  cases  are  nearly  always  toxic,  run  down 
in  general  health,  and  for  that  reason  it  is  a  good  plan,  twice  or  thrice 
weekly,  to  substitute  for  the  local  the  body  apparatus,  raising  the 
temperature  250°  to  300°  F.  for  thirty  to  sixty  minutes.  This  treat- 
ment should,  as  a  rule,  be  followed  by  the  horizontal  rain  bath  at  75° 
F.  for  one- fourth  to  one-half  minute.  In  some  forms  of  chronic  ulcer, 
where  the  edges  are  hard  and  everted,  where  the  vitality  of  the  part 
is  very  low,  it  is  an  excellent  plan  to  make  first  the  application  of  the 


HYDROTHERAPY  IN  SURGERY.  593 

superheated  dry  hot  air,  following  this  with  the  Scottish  or  alternating 
jet  douche  to  the  spine,  at  a  temperature  of  110°  to  120°  I\,  pressure 
thirty  pounds,  for  one- fourth  to  one-half  minute,  and  gently  to  the 
ulcerated  surface,  changing  to  a  temperature  of  60°  to  50°  F.  for  five 
to  ten  seconds.  After  the  patient  has  been  dried  and  reaction  secured 
the  ulcer  may  he  dressed  with  bovinine  and  supported  again  by  the 
application  of  a  firm  spiral  reverse  bandage.  In  acute  ulcer  Kaposi 
has  found  the  prolonged  neutral  immersion  bath  at  92°  to  94°  F.  for 
two  to  six  hours  to  lessen  the  pain,  lower  the  temperature,  diminish 
congestion  and  favor  healing,  while  Gushing  suggests  the  use  of  local 
hypodermoclysis  of  normal  saline  solution  to  the  ulcer  itself. 

The  author  can  speak  favorably  in  some  cases  of  the  static  wave, 
negative  galvanic  and  the  high  frequency  electrical  currents  applied 
to  the  surfaces  of  the  ulcer,  in  addition  to  the  treatment  with  the 
superheated  dry  hot  air. 

Gangrene. 

Gangrene,  or  mortification,  is  death  in  mass  of  a  portion  of  the 
living  body,  large  enough  to  be  visible  to  the  eye.  It  may  occur  from 
injury,  either  chemical  or  mechanical,  heat  or  cold,  bad  health,  cir- 
culatory obstruction,  trophic  and  vasomotor  nerve  disturbance,  or  from 
microbic  infection.  The  immediate  or  essential  feature  is  that  the 
tissues  are  shut  off  from  their  arterial  blood  supply,  being  thus  robbed 
of  the  nourishment  that  supports  cell  nutrition. 

The  method  herewith  suggested  for  the  treatment  of  gangrene 
may  be  used  first  in  stimulating  the  circulation  and  vitality  of 
the  part  to  prevent  and  later  to  favor  the  line  of  demarcation  be- 
tween the  gangrenous  and  healthy  tissues.  In  gangrene,  toxic  and 
septic  material  of  necessity  enters  the  system,  and  for  that  reason 
the  combined  local  and  general  method  is  the  best.  The  superheated 
dry  hot  air  local  apparatus  at  350°  to  400°  F.  for  one  hour  to  the  part 
affected  three  days  in  the  week,  and  a  general  application  of  the  body 
apparatus  three  days  in  the  week,  will  go  a  long  way  towards  building 
up  the  vitality  and  the  general  health  of  the  patient,  as  well  as  the 
results  above  outlined,  with  the  local  condition.  The  general  state  of 
the  patient  will  have  to  be  carefully  studied  as  to  whether  tonic  meas- 
ures such  as  the  cold  sponge  shall  be  used,  or  whether  we  can  employ 
the  horizontal  rain  bath  or  other  hydriatic  measures. 

Septic  Infection. 

Sepsis  is  a  febrile  malady  due  to  the  introduction  into  the  blood  of 
pyogenic  organisms  or  their  products,  or  of  saprophytic  bacteria. 
No  one  special  micro-organism  causes  the  condition,  but  any  one  that 
produces  inflammation  is  sufficient.  Septic  intoxication  (sapremia) 
results  from  absorption  of  the  poisonous  ptomaines  from  the  putre- 
factive area.     These  toxins  are  small  in  amount,  and  in  their  toxic 


594  PRACTICAL  HYDROTHERAPY. 

actions  resemble  the  alkaloids,  in  that  small  doses  produce  profound 
and  widespread  results. 

The  toxins  of  both  the  saprophytic  and  pyogenetic  germs  may  be 
simultaneously  absorbed.  The  condition  may  be  slight  or  grave 
according  to  the  dosage.  Surgical  fever  is  a  mild  form  of  septic 
intoxication.  It  may  follow  labor,  abortion,  amputation,  from  pent-up 
wounds.  It  means  an  illy-drained  wound,  a  fermenting  and  putrid 
blood  clot  or  wound  fluid.  In  true  septic  infection  the  blood  contains 
not  alone  the  toxins,  but  pyogenic  bacteria  themselves.  The  tissues 
themselves  are  suppurating  and  toxins  enter  by  the  lymphatics.  The 
symptoms  depend  on  the  dose.  The  blood  is  truly  infective  and 
capable  of  reproducing  the  disease.  It  may  arise  from  some  nidus  of 
suppuration  that  has  not  been  discovered,  such  as  otitis  media,  sup- 
puration of  the  tonsil,  gonorrhea,  etc.  The  germs  are  usually  staphy- 
lococci and  streptococci.  There  is  fever,  sweats,  a  small  and  weak 
pulse,  that  is  frequent  and  compressible ;  the  tongue  is  dry  and  brown, 
with  a  red  tip;  sordes  on  the  teeth,  prostration,  perhaps  low  delirium. 
Visceral  congestion,  profound  anemia  and  leucocytosis  occur.  The 
outlook  in  septic  intoxication  is  good;  in  septic  infection  bad.  There 
is  danger  of  all  forms  of  inflammatory  complications  of  serous  mem- 
branes.    It  may  be  local  or  general. 

Septic  infection  occurs  with  a  moderate  degree  of  frequency  to- 
day in  spite  of  the  most  careful  observance  of  aseptic  and  antiseptic 
technique.  Prevention  is,  of  course,  the  best  method,  but  at  times  it  is 
impossible  of  attainment. 

The  surgeon  should  first  open  and  drain  the  nidus  or  the 
center  of  infection,  and  render  it  as  far  as  possible  antiseptic  and 
sterile,  at  the  same  time  administering  salines  to  the  point  of  free 
catharsis,  and  alkaline  diuretics.  Milk,  milk  and  lime-water,  pep- 
tonoids,  etc.,  are  indicated,  as  well  as  strychnia  and  digitalis.  In  these 
cases  hypodermocylsis  of  normal  saline  solution  is  very  valuable,  in 
that  it  dilutes  the  poison,  favors  elimination,  fills  the  blood-vessels  and 
stimulates  the  heart,  kidneys  and  skin.  Where  heart  failure  is  present 
the  compress  and  ice-bag  to  the  precordium  will  be  found  most  useful, 
but  the  best  treatment  is  a  combination  of  the  local  and  general  super- 
heated dry  hot  air,  giving  the  body  apparatus  at  300°  to  400°  F.  for 
one  hour  daily,  with  one  or  two  applications  of  the  local  apparatus  at 
350°  to  400°  F.  for  one  hour  to  the  local  area  of  infection.  The  action 
of  this  agent  upon  saprophytic  and  pyogenic  bacteria  is  destructive ;  it 
stimulates  circulation,  favors  leucocytosis,  arouses  the  trophic  nerve 
centers,  elevates  the  resisting  powers  of  the  tissues  and  burns  up 
toxins.  It  relieves  pain,  provided  there  is  drainage,  and  brings-  fresh 
reparative  material  to  the  part ;  lessens  exudation  and  swelling ;  in- 
creases cellular  activity ;  induces  repair  and  prevents  destruction. 

From  the  beginning,  before  and  soon  after  the  onset  of  surgical 


HYDROTHERAPY  IN  SURGERY.  595 

fever,  we  should  institute  those  measures  that  will  stimulate  vital  re- 
sistance. These  cases  demand,  in  addition  to  the  superheated  hot  air, 
the  sponge  at  60°  to  50°  F.,  with  friction,  every  two  to  four  hours,  as 
well  as  the  use  of  compresses  over  the  affected  area.  With  a  little 
care  and  judgment  these  measures  may  be  adopted  to  almost  any  ci 

Osteitis;  Periosteitis;  Osteoperiosteitis;  Osteomyelitis. 

The  foregoing  inflammatory  group  represents  inflammations  of  the 
bone,  periosteum,  bone  and  periosteum,  and  bone  and  medulla  re- 
spectively. They  may  be  acute  or  chronic.  They  may  be  provoked 
by  trauma,  constitutional  maladies  or  diatheses,  extension  of  inflam- 
mation from  other  structures  or  from  infection.  Termination  may  be 
in  resolution,  sclerosis,  suppuration  or  necrosis.  Severe  pain,  worse 
at  night,  aggravated  by  dependent  position;  tenderness  on  pressure 
and  percussion,  swelling,  discoloration  and  some  fever  are  usually 
present.  Many  chronic  forms  are  syphilitic.  These  are  grave  diseases. 
and  their  outcome  uncertain.  Many  cases  would  in  all  probability  be 
completely  checked  in  the  early  stages  by  treatment,  and  those  that 
were  not  would  be  better  prepared  for  operative  work  were  the  meas- 
ures herein  suggested  carried  out. 

All  hygienic  measures  should  be  instituted  and  a  generous 
and  nutritious  diet  prescribed.  The  secretions  and  excretions 
should  be  stimulated,  and  the  following  method  instituted :  To  the 
parts  affected  the  superheated  dry  hot  air  local  apparatus  at  300°  to 
400°  F.,  once  or  twice  daily,  depending  upon  the  gravity  of  the  case, 
and  twice  or  three  times  weekly  the  body  apparatus  at  250°  to  300°  F. 
for  one  hour,  or,  what  is  far  better,  the  daily  use  of  the  body  and 
twice  daily  the  use  of  the  local  apparatus,  the  latter  morning  and 
night  and  the  former  during  the  middle  of  the  day.  Tonic  hydro- 
therapy should  not  be  used  at  first  in  these  cases,  unless  we  use  the 
cold  sponge  at  60°  to  50°  F.  to  those  parts  of  the  body  not  infected. 
As  soon  as  the  inflammatory  trouble  has  begun  to  subside  we  may 
commence  to  build  up  the  general  health  by  diminishing  the  number 
of  the  applications  of  the  superheated  dry  hot  air  to  one  daily,  and 
following  this  with  the  horizontal  rain  bath  at  100°  to  102°  F.  for  one 
minute,  reduced  to  60°  F.  for  one- fourth  minute,  and  later,  if  the 
patient  can  stand  same,  add  to  the  above  the  jet  douche  to  the  spine 
at  60°  for  five  to  ten  seconds. 

Appendicitis. 

It  is  generally  admitted  that  the  medical  treatment  of  this  disease 
is  that  of  Dr.  A.  J.  Ochsner,  who  has  kindly  prepared,  at  the  author's 
request,  a  description  of  his  method,  and  for  which  the  author  here- 
with expresses  his  appreciation : 

"The  method   of    treatment   of    acute  appendicitis  known   as   the 


596  PRACTICAL  HYDROTHERAPY. 

starvation  method  is  applicable  to  a  definite  limited  class  of  cases, 
namely,  those  of  severe  acute  appendicitis  usually  of  more  than  twenty- 
four  hours'  standing,  with  gangrene  or  perforation  of  the  appendix, 
with  a  condition  in  which  the  infectious  material  has  already  extended 
beyond  the  tissues  of  the  appendix. 

"The  treatment  is  applicable  especially  to  cases  that  come  under 
the  physician's  care  on  the  third,  fourth,  fifth  or  sixth  day  of  a  severe 
acute  attack — cases  which  were  classified  by  Mynter  as  beginning 
diffuse  peritonitis,  and  which  have  been  classed  by  other  authors  as 
cases  of  spreading  or  advancing  peritonitis  due  to  a  gangrenous  or 
perforated  appendix. 

"The  treatment  is  not  intended  for  cases  of  acute  appendicitis  in 
which  the  infectious  material  is  still  confined  to  the  appendix,  because 
in  these  cases  the  results  obtained  from  removing  the  appendix  im- 
mediately are  so  excellent  that  nothing  could  be  gained  by  substituting 
any  other  form  of  treatment,  unless  there  were  available  no  surgeon 
competent  to  safely  perform  any  simple  abdominal  operation. 

"The  same  is  true  concerning  chronic  appendicitis  in  the  interval 
between  acute  attacks.  For  this  limited  class  of  cases,  then,  I  have 
advised  this  definite  method  of  treatment,  which  consists  in  the  re- 
moval of  all  contents  of  the  stomach  by  carefully  performed  lavage. 

"For  this  purpose  the  patient  is  placed  upon  his  right  side,  the 
pharynx  is  thoroughly  sprayed  with  2  per  cent,  cocaine,  which  is  left 
in  contact  with  the  pharynx  for  a  period  of  five  to  ten  minutes,  then 
a  thoroughly  oiled  stomach-tube  is  passed  into  the  stomach. 

"Any  fluid  that  may  be  present  is  permitted  to  drain  off,  then  from 
one-half  of  a  pint  to  one  pint  of  warm  normal  salt  solution  is  poured 
into  the  stomach.  The  solution  should  be  at  a  temperature  of  98° 
to  105°  F.  This  solution  is  siphoned  out  again,  and  this  repeated 
until  the  fluid  returns  perfectly  clear :  then  the  foot  of  the  bed  is  ele- 
vated and  the  tube  is  withdrawn  slowly  so  as  to  leave  the  stomach 
empty,  the  lower  end  of  the  bed  being  elevated  while  the  tube  is 
being  removed  in  order  that  the  siphonage  may  be  continued  while 
the  tube  is  being  withdrawn.  It  is  important  that  the  tube  be  with- 
drawn slowly  in  order  that  the  fluid  will  be  thoroughly  removed.  It 
is  also  important  that  gastric  lavage  be  employed  in  every  case  in 
which  nausea  or  vomiting  is  present. 

"Many  cases  that  have  vomited  repeatedly  for  a  number  of  hours 
still  carry  in  their  stomachs  from  a  few  ounces  to  a  quart  of  decom- 
posed material.  It  is  frequently  thought  that  because  the  patient  has 
vomited  so  constantly  that  his  stomach  cannot  contain  any  more 
fluid,  but  experience  has  shown  that  precisely  the  opposite  condition 
is  true. 

"There  is  in  some  cases  regurgitation  of  intestinal  contents  from 
the  intestines  into  the  stomach,  and  it  is  the  removal  of  this  substance 
that  gives  great  relief  to  the  patient. 

"In  case  nausea  or  vomiting  occurs  after  the  completion  of  gastric 
lavage,  the  latter  should  invariably  be  repeated.  This,  however,  is 
usually  not  necessary,  and  it  is  rarely  necessary  to  repeat  it  more 
than  two  or  three  times. 

"The  patient  is  permitted  to  take  absolutely  nothing  by  mouth, 
not  even  water,  but  he  may  rinse  his  mouth  with  cold  water,  being 
careful  not  to  swallow  any  of  it. 

"The  nutrition  of  the  patient  is  supplied  by  employing  a  definite 


HYDROTHERAPY  IN  SURGERY.  597 

form  of  rectal  feeding.  Much  depends  upon  the  fact  that  this  is 
carried  out  exactly  according  to  the  following  directions: 

"One  ounce  of  any  of  the  pre-digested  liquid  foods  in  the  market 
is  dissolved  in  three  ounces  of  warm  normal  salt  solution  and  then  is 
injected  into  the  rectum  in  the  following  manner: 

"A  soft  rubber  catheter,  not  to  exceed  in  size  a  Xo.  10  English 
or  No.  25  French  gauge,  is  thoroughly  lubricated,  a  small  funnel  or 
a  good-sized  syringe  is  inserted  in  the  open  end  of  this  catheter.  In 
case  a  syringe  is  used  the  plunger  is  not  employed.  The  catheter  is 
then  introduced  into  the  rectum  a  distance  not  to  exceed  three  inches 
and  the  liquid  food  is  poured  into  the  funnel  or  glass  syringe  and  is 
permitted  to  enter  the  rectum  by  gravitation.  It  is  important  that  the 
catheter  be  not  introduced  more  than  three  inches ;  it  is  also  important 
that  no  other  food  be  substituted  for  the  one  mentioned. 

"1  have  seen  irritation  resulting  many  times  from  the  use  of  eggs, 
peptonized  milk,  mixtures  of  soup  or  gruel  and  a  number  of  other 
forms  of  food  in  cases  in  which  the  irritation  would  subside  at  once 
when  the  above  plan  was  vigorously  followed. 

"This  food  is  given  every  three  or  four  hours.  If  the  patient 
suffers  any  pain,  twenty  drops  of  deodorized  tincture  of  opium  is 
added  to  each  feeding.  This  is  repeated  until  the  pain  has  perma- 
nently subsided.  It  may  be  reduced  to  ten  drops  or  increased  to 
thirty  drops  as  indicated  in  the  individual  case. 

"At  the  same  time  the  head  of  the  bed  is  elevated  from  twelve  to 
twenty-four  inches,  in  accordance  with  the  severity  of  the  case,  in 
order  to  have  the  advantage  of  gravity  toward  the  pelvis  in  the  peri- 
toneal cavity,  making  use  of  the  important  principle  introduced  by 
Fowler. 

"After  the  temperature  and  pulse  are  approximately  normal  and 
the  abdominal  muscles  have  become  relaxed,  the  patient  may  be 
given  small  sips  of  hot  water  by  mouth  and  later  en  cold  water. 
It  is  well  not  to  begin  this  for  a  day  or  two  after  the  beginning  of 
this  treatment. 

"In  case  of  thirst,  eight  ounces  of  warm  normal  salt  solution  may 
be  given  by  rectum  in  the  same  manner  as  the  rectal  feeding  every 
half-hour  until  the  thirst  has  subsided. 

"During  all  of  this  time  it  is  important  that  the  abdomen  be  not 
manipulated  violently.  It  is  an  easy  matter  during  the  physician's 
examination  to  distribute  infection  by  violent  diagnostic  manipu- 
lation. 

"After  the  acute  symptoms  have  all  subsided  for  two  or  three 
days,  small  quantities  of  commercial  beef-tea  may  be  given  by  mouth, 
then  broth,  and  then  the  patient  may  be  permitted  to  chew  steak  to 
get  the  juice  but  not  the  pulp,  and  then  a  general  liquid  diet  may  be 
given. 

"It  is  well  during  the  starvation  period  to  permit  the  patient  to 
chew  gum  in  order  to  increase  the  flow  of  saliva,  and  thus  prevent 
any  infection  of  the  parotid  glands. 

"If  this  form  of  treatment  is  carried  out  accurately  in  this  lim- 
ited class  of  cases,  there  can  be  no  doubt  but  that  the  mortality  will 
be   enormously   decreased." 

During  the  inter-appendicial  period  the  stimulating  compress  should 
be  worn,  as  its  use  favors  permanent  resolution  and  prevents  recur- 


598  PRACTICAL  HYDROTHERAPY. 

rence.  Tonic  hydrotherapy  is  indicated  after  the  acute  attack  and 
during  convalescence,  whether  the  case  has  been  operated  upon  or 
not.  Of  these  measures,  the  electric  light  bath,  followed  by  the  hori- 
zontal rain  bath,  jet  and  fan  douches,  are  the  best. 


INDEX. 


Abdominal  surgery,  588. 
Ablution,  115. 
Abortion,   521. 

bath,  cold  sitz,  522. 
horizontal  rain,  521. 
incandescent   electric  light,   521. 
Xauhcim,  521. 
sponge,  cold,  521. 
causes,  521. 
definition,  521. 
hygiene,   521. 
sheet,  dripping,  521. 
treatment.  521. 
Absorption,  action  of  sunlight  upon,  65. 
physiological  action  of  hydrotherapy 
upon,  35. 
Abstinence,  from  water,  55. 
Achlorhydria.        S  e  e       hyposecretion, 

states  of. 
Achylia    gastrica.      See    hyposecretion, 

states  of. 
Acne,  559. 

bath,  horizontal  rain,  560. 
hot  air,  560. 

incandescent  electric  light,  560. 
warm   full,  560. 
causes,  559. 
compress,  cold,  560. 
definition,  559. 
diet,  560. 
douche,  fan,  560. 

jet,  560. 
fomentation,  123,  560. 
pathology,  559. 
sponge,  cold,  560. 
superheated  dry  hot  air,  560. 
surf  bathing,  560. 
treatment,  559. 
vulgaris.  559. 
Acute  gastritis,  233.  Sec  gastritis,  acute. 
Adamkiewicz,  17. 
Adaptability  of  water,   12. 
Adipositas,  302. 
Adynamia,  arc  light  in,  74. 
Affusion.  183. 
apparatus,  183. 
in  anidrosis,  570. 
in  asthma,  267. 
in  endometritis-,  chronic,  518. 
in  epilepsy,  378. 
in  fever,  scarlet,  216. 
in  hysteria.  372. 
in  insolation,  412. 
in  measles,  214. 
in  migraine,  391. 
in  myelitis,  chronic.  351. 
in  neurasthenia,  366. 
in  neurosis,  occupation,  402. 
in  rearing  of  delicate  child,  503. 
in  spinal  curvature,  584. 

599 


Affusion  in  syphilis,  545. 
in  vertigo,  398. 
technique,  183. 

Age  and  hydrotherapy,   100. 

Agitans,  paralysis,  403.     Sec  paralysis 

agitans. 
Alcohol,  457. 
as  a  food,  458. 
as  cau^c  of  disease,  457. 

insanity,  457. 
chemical  composition  of,  458. 
consumption  of,  458. 
drinker's  appearance,  459. 
hereditary  influence  of,  457. 
kinds  of  drinking,  459. 
physiological  action  upon  blood,  464. 
circulation,  462. 
heart,  462. 
kidney,  466. 
liver,  462. 
lungs,  466. 
metabolism,  467. 
mouth  and  gums,  460. 
mucous  membranes,  468. 
muscular  system,  465. 
nervous  system,  469. 
pulse,  463. 
sexual  system,  472. 
skin,  468. 
stomach,  461. 
temperature,  467. 
sensitiveness  to,  460. 
Alcoholic  delirium,  acute,  457,  484. 
bath,  hot  full  in,  152,  479. 
intoxication,  acute,  457,  477. 
bath,  half,  480. 

horizontal  rain,  480. 
hot  air,  480. 

incandescent   electric  light,  480. 
convalescence  from,  479. 
diet  in,  479. 
douche,  jet,  480. 
effects  of,  477. 
frequency  of,  477. 
lavage  in,  478. 
pack,  full  dry.  479. 

full  wet,  479. 
pathology  of,  47S. 
prognosis   of,  478. 
treatment  of,  478. 
mania,  acute,  457,  487. 
Alcoholism,  457. 

as  cause  of  many  diseases,  474. 
mental  diseases,  472. 
organic  diseases.  473. 
bath,  horizontal  rain,  493. 
hot  full,  493. 

incandescent  electric  light,  493. 
Turkish,  493. 
causes,  exciting  of,  476. 
xl 


600 


INDEX. 


Alcoholism,   convalescence   from,   495. 
definition,  457,  489. 
delusions  of,  471. 
douches  in,   193. 

fan,  494. 

jet,  494. 
hypnotism  in,  495. 
influence  of  climate  upon.  475. 

education  upon,  476. 

occupation   upon,  474. 

race  upon,  475. 

social  status  upon,  473. 
insomnia  of,  471. 

medical  prescription,  cause  of,  460. 
motor   disturbances   of,   471. 
pack  blanket,  494. 

full  wet  in,   138. 
pathological  anatomy  of,  477. 
prophylaxis  of,  497. 
"quick  cures,"  492. 
religious   revivals   in,  495. 
symptoms,  489. 
treatment,  481. 
water  drinking  in,  60. 
Alopecia,  566. 

bath,  horizontal  rain.  567. 

incandescent  electric  light,  567. 
causes,  566. 

compress,   stimulating.   567. 
definition,  566. 
douche,  fan,  567. 

jet,  567. 
pathology,  567. 
shampoo,  567. 
treatment,   567. 
Alopecia  areata,  566. 
Alternate  hot  and  cold  applications,  100. 
sponge,   118. 
apparatus,  118. 
in  arthritis,  traumatic,  118. 
in  contusions,  118. 
in  headache,   118. 
in  insomnia,  118. 
in  joint  diseases,  118. 
in  myositis,  118. 
in  nervousness,   US. 
in  neuralgia,  intercostal,  118. 
in  neurasthenia,   118. 
in  pains  of  trauma,  118. 
in  sprains.  118. 
to  spine,  118. 
technique,  118. 

douche.     See  douche,   Scottish. 
Amenorrhea,  508. 
bag.  Chapman's  ioe,  511. 
bath,  horizontal  rain,  510. 

incandescent    electric    light,    510. 

cold  sitz,  510. 

hot   sitz.   511. 
causes,  508. 
definition,  508. 
diagnosis,    509. 
diet,  510. 
douche,   Scottish,  510. 

vaginal,  511. 
fomentation,   122,  511 
pack,  half  wet.  511. 

pelvic,  511. 


Amenorrhea,  sheet,  dripping,  in,  510. 

sponge,  cold,  510. 

treatment,  510. 

types  of,  509. 
Anacidity.  See  hyposecretion,  states  of. 
Anal  tenesmus,  hot  sitz  bath  in,  147. 
Anasarca,  281. 
Anatomv  of  skin,  11,  13. 
Anders,  J.  M.,  303. 
Anemia,  312. 

bag,   ice,  314. 
hot   air,   313. 

bath,  half.  313,  149. 
horizontal  rain,  313. 
incandescent  electric  light,  313,  73. 
neutral.  314. 

causes,  312. 

definition,  312. 

diet,  313. 

douche,  fan,  313. 
jet,  313. 

douches  in,   192. 

hydrotherapy  of,   104. 

hygiene,  313. 

pack,  full  dry,  313. 

sheet,  dripping,  313,  120. 

sponge,  cold,  313. 

sunlight   in,  67. 

treatment,  313. 
Anemia,  pernicious,  314. 

bag,  ice,  315. 

bath,  incandescent  electric  light,  315. 

causes.  314. 

definition,  314. 

diet.  314. 

hygiene,  314. 

treatment,  314. 

water   drinking,   315. 
Anemia,  splenic.  314. 
Angelo,  Michael,  4. 
Angina  pectoris,  331. 

ba"'   ice,  332. 

Chapman's  spinal  ice,  332. 

bath,  Nauheim,  332. 

causes,  331. 

definition,  331. 

diet,  331. 

hygiene,   331. 

treatment.  331. 
Angio-neurotic   edema.    556. 
Anidrosis,  569. 

affusion,   570. 

bath,  half,  570. 
hot   air,   569. 
hot  full,  569. 
horizontal  rain,  570. 
incandescent  electric  light,  569. 
Turkish.  569. 

causes,  569. 

definition,  569. 

douche,   fan,   570. 
jet,  570. 

pack,  full  wet,  570. 

sheet,  dripping,  570. 

superheated  dry  hot  air,  569. 

treatment.  569. 
Ankylosis,  591. 

causes,  591. 


INDEX. 


601 


Ankylosis,  definition,  591. 

douche,    fan,    592. 
Scottish,  592. 

superheated  dry  hot  air,  591. 

symptoms,  591. 

treatment,  591. 

varieties,  591. 
Ankylosis,    fibrous,    local    superh 

dry  hot  air,  84. 
Anorexia,   250. 

Antiseptic  action  of  water,   12. 
Anns,   fissure  of,  552. 

bag,  ice,  552. 

bath,  hot  sitz,  552. 

causes,  552. 

definition,  552. 

douche,   perineal,   552. 

fomentation,   552. 

pathology,  552. 

symptoms,  552. 

treatment,  552. 
Aortic   regurgitation,  326. 

stenosis,  326. 
Apepsia.    See  hyposecretion.   states  of. 
Apoplexy,    cerebral,   344.      Sec   hemor- 
rhage, cerebral. 
Appendicitis,  595. 

bath,  horizontal  rain,  598. 
incandescent  electric  light,  598. 

compress,  stimualting,   128,  595. 

douche,  fan,  59S. 
jet,  598. 

bag,  ice,  126. 

Ochsner's  method  in,  595. 
Appetite,  derangements  of,  250. 

ice  bag  in,  126. 
Aqueduct,  Antonine,  3. 
Arc  light,  action  on  vegetation,  7. 

in  adynamia,  74. 

in  neurasthenia,  74. 

in  skin  diseases,  74. 
Arc  light  bath,  71. 

physiological  action,   71. 

technique,  71. 
Aristophanes,  2. 
Arterial  hypertension.  329. 

causes,  329. 

definition,  329. 

diet,  329. 

hygiene,  329. 

treatment,  329. 
Arterio-sclerosis,  329. 

bath,  horizontal  rain,  330. 

incandescent    electric   light,    330. 
Nauheim,  330. 

causes,  329. 

definition,   329. 

diet,  329. 

hygiene,  329. 

pack,   full  dry,  330. 

rules  about,  96. 

sponge,  cold,  330. 

treatment,  329. 
Arthritis,  589. 

deformans,  294. 

rheumatoid,  294. 
bath,     incandescent    electric    light, 
295. 


Arthritis,  bath,  mineral,  in,  295. 
causes,  294. 

compress,   stimulating,  294. 
definition,  294. 
diet,  294. 

douche,   Scottish,  294. 
hygiene,   294. 

superheated  dry  ho1  air,  294. 
treatment,  294. 
traumatic,     alternate     hot     and     cold 
sponge  in,   1 18. 
Arythmia,  cardiac,  332,  ?>?>?>. 
Ascites,  281. 
bag,  ice,  282. 
bath,  horizontal  rain,  282. 
hot  air,  282. 

incandescent   electric  light,  282. 
causes,  281. 
compress,  trunk,  282. 
convalescence,    treatment.    282. 
definition,  281. 
douche,  Scottish,  282. 
pack,  half  wet,  2X2. 
superheated  dry  hot  air,  282. 
treatment,  281. 
water  drinking,  281. 
Asclepiades.  2. 
Ashburn,  231. 
Asklepios,   1. 
Assimilation,   action   of   sunlight   upon, 

65. 
Asthenopia,  578. 
compress,  cold,  578. 
fomentation,  578. 
Asthma,  bronchial,  267. 
affusion,  267. 
bag,  Chapman's  ice,  87. 
bath,  horizontal  rain,  268. 
hot  full,  267. 

incandescent  electric  light,  268. 
causes,  267. 

compress,   stimulating,  267. 
definition,  267. 
diet,  267. 
douche,  fan,  268. 
fomentation,  267. 
hygiene,  267. 
sheet,  dripping,  268. 
sponge,  cold,  268. 
symptoms,  267. 
treatment,  267. 
Ataxia,     Friedreich's,     352,     360.       See 
ataxia,  locomotor, 
hereditary     spinal,     352,     360.      See 

ataxia,  locomotor, 
locomotor,  352,  355,  356. 
affusion,  354. 
bath,  half,  354. 

horizontal  rain,  354. 
incandescent   electric  light,   354. 
Nauheim,  354. 
bladder,  treatment,  355. 
causes,  352. 

Charcot  joints,  treatment,  355. 
crises,  treatment,  355. 
definition,  352. 
douches,  355. 
exercises  in,  358. 


602 


INDEX. 


Ataxia,  locomotor,  fomentation  in,  355. 
hygiene,  353. 
pain,  treatment  of,  355. 
pathology,  352. 
rub,  salt,  354. 
treatment,  353. 
schedule,  358. 
Ataxic  paraplegia,  352,  360.  See  ataxia, 

locomotor. 
Atony,  gastric,  235. 
bath,   hot  air,  235. 
horizontal  rain,  235. 
incandescent   electric  light,   235. 
causes,  235. 
definition,  235. 
diet,  236. 
douche,  fan,  235. 

jet,  235. 
hygiene,  235. 
lavage,  235. 
pack,  full  dry,  235. 
pathology,  235. 
rub,  salt,  235. 
sheet,  dripping,  235. 
symptoms,  235. 
treatment,   236. 
Atrophy,   chronic   muscular,   353.      See 

ataxia,   locomotor. 
Attendant  in  bath  room,   112. 
Aufrecht,  221,  343. 
Aurii,  tinnitus,  396.     See  vertigo. 
Autotoxemia,  half  bath  in,  149. 

Backache,  fomentation  in,   123. 
Bacteria,  action  of  sunlight  upon,  63. 
Baelz  (of  Tokio),  Prof.,  151,  152,  153. 
Bag,  bran,  hot,  85. 

Chapman's   ice   in   amenorrhea,   511. 

in  angina  pectoris,  332. 

in  gastritis,  chronic,  235. 

in  hemorrhage,    pulmonary,    261. 

in  hemorrhage,  uterine,  520. 

in  insomnia,  396. 

in  meningitis,  344. 

in  myelitis,  acute,  349. 

in  seasickness,  400. 
Chapman's  hot  water,  260. 

in  congestion,  pulmonary,  260. 
ice,  in  anemia,  314. 

in  anemia,   pernicious,   315. 

in  angina  pectoris,   332. 

in  anus,  fissure  of,  552. 

in  ascites,  282. 

in  cardiac  collapse,  334. 

in  cardiac   disease,   organic,   327. 

in  cardiac  hypertrophy,  328. 

in  cellulitis,  pelvic,  acute,  528. 
chronic,   529. 

in  congestion,  pelvic,   529. 

in  delirium,    acute   alcoholic,   485. 

in  dilatation,  cardiac,  327. 

in  dislocations,    583. 

in  edema,   pulmonary,   261. 

in  endocarditis,   316. 
chronic,  317. 

in  enteritis,   acute,  243,   244. 
chronic,  246. 

in  epididymitis,  534. 


Bag,  ice,  in  erysipelas,  220. 

in  fever,  surgical,  587. 

in  gastro-intestinal   neuroses,   251. 

in  gastritis,  acute,  233. 

in  goitre,   exophthalmic,   382. 

in  gonorrhea,  534. 

in  heart  diseases,   functional,  334. 

in  hemorrhage,  cerebral,  346. 

in  hemorrhage,    pulmonary,    261. 

in  hemorrhoids,   554. 

in  hyperemia,  renal,  306. 

in  hyposecretion,   states   of,  242. 

in  infection,  septic,  593. 

in  insolation,  413. 

in  insomnia,   396. 

in  melancholia,  421. 

in  meningitis,  344. 

in  migraine,  392. 

in  nephritis,  acute,  208. 
chronic,  310. 

in  neuritis,  multiple,  340. 

in  oophoritis,   acute,   525. 

in  orchitis,  535. 

in  pericarditis,   316. 

in  peritonitis,  acute,  280. 

in  pleuritis,  acute,  278. 

in  pneumonia,  264. 

in  prostatitis,  chronic,  537. 

in  rheumatism,      acute,      articular, 
291. 

in  salpingitis,  acute,  524. 

in  shock,  surgical,  585. 

in  surgery,  abdominal,  588. 

in  synovitis,  acute,  590. 

in  tuberculosis,   274. 

in  ulcer,   gastric,  241. 

in  uremia,  311. 

in  urine,  suppression  of,  547. 

in  vertigo,  397. 
hot  water,  85. 
salt,  hot,  85. 
sand,  hot,  85. 
Baldness,  566. 
Barker,  206. 

Baruch,  Simon,  10,  28,  37,  50,  128,  130, 
145,    154,    159,    183,    202,    203, 
244,  266,  274,  413. 
Bath,  arc  light,  71. 

in  cirrhosis,  hepatic,  286. 
coil  bed,   167. 

apparatus,    167. 

technique,   167. 
daily  cold,  101. 
continuous,  158. 

apparatus,   158. 

in  bed  sores,  159,  573. 

in  burns,  160,  563. 

in  cystitis,  548. 

in  eczema,  557. 

in  fractures,   583. 

in  Leukebad,    160. 

in  locomotor  ataxia,  159,  160. 

in  myelitis,   159,   160. 
acute,  349. 
chronic,  352. 

in  pemphigus,  558. 

in  psoriasis,  561. 

in  spinal  diseases,  159,   160. 


INDEX. 


603 


Bath,  continuous,  technique,  158. 
therapeutics  of,  159. 
in  ulcers,   59.1. 
in  variola,   224. 
cleansing.      See    cleansing    hath. 
foot,    141. 
apparatus,    141. 
technique,   141. 
cold  foot,  142. 

action  upon  hladder,  142. 
apparatus,   142. 
contraindications,   142. 
in  cerebral    congestion,    142. 
in  cold  feet,   142,  574. 
in  enuresis,   551. 
in  hyperidrosis,  569. 
in  insomnia,   142,  396. 
in  sweating  feet,  142. 
physiological  action,  142,   170. 
technique,  142. 
hot  foot,  141. 
in  contusions,  141. 
in  dysentery,  acute,  245. 
in  edema,  pulmonary,  261. 
in  enteritis,  chronic.  247. 
in  gastritis,  acute,  233. 
in  "headfullness,"   142. 
in  hemorrhage,  uterine,  520. 
in  hemorrhoids,  554. 
in  inflammations,    141. 
in  migraine,  392. 
in  myalgia,   141. 
in  rhinitis,  acute,  253. 

chronic,  255. 
in  sprains,   141. 
in  surgery,   142. 
in  ulcers,   142. 
physiological  action,   141. 
temperature,  141. 
cold  full,  166. 

action  upon  blood,   174. 

circulation,   170. 

elimination,  173. 

metabolism,  173. 

nervous  system,   171. 

respiration,   172. 

temperature,  171. 
action  in  typhoid,  205. 
after  treatment,  168. 
alcohol  with,  206. 
apparatus,  167. 

hospital,   166. 
friction  with.  168,  170. 
in  erysipelas,  220. 
in  fever,    Montana   spotted,   231. 

typhus,  231. 
in  insolation,  413. 
in  neglected  typhoid,  207. 
in  pneumonia,  266. 
in  typhoid,  203. 
in  typhus,  230. 
in  variola,   224. 
preparation  for,  168. 
technique,    167. 
temperature,   168. 
therapeutics  of,   174. 
cleansing,  155. 
hot  full,   150. 


Bath,  hot   full,  action  upon  circulation, 

150. 

elimination.    151. 

metabolism,  151. 

nervous  system,  151. 

respiration,  151. 

temperature,   151. 
apparatus,  150. 
contraindications,  153. 
in  alcoholic      intoxication,      acute, 

479. 
in  alcoholism,  chronic,  493. 
in  anidrosis,  569. 
in  asthma,  267. 
in  bronchitis,   capillary,    153. 
in  colic,  renal,  312. 
in  congestion,  pulmonary,  260. 
in  convulsions,   infantile,   153. 
in  delirium,  acute  alcoholic,  484. 
in  diphtheria,  218. 
in  dislocations,    582. 
in  dysmenorrhea,  515. 
in  eclampsia,  522. 
in  fever,  scarlet,  216. 
in  gout,  296. 
in  grippe,  210. 

in  hypersecretion,  states  of,  239. 
in  laryngitis,   spasmodic,  256. 
in  leprosy,  575. 
in  lithemia,  299. 
in  malaria,  212. 
in  measles,  214. 
in  meningitis,  343. 
in  meningitis,   cerebro-spinal,    153. 
in  menopause,  532. 
in  nephritis,  acute,  153,  308. 
in  neuritis,  multiple,  340. 
in  oophoritis,  chronic,  526. 
in  pneumonia,  153,  265. 
in  rheumatism,    chronic    articular, 

152,  292. 
in  rhinitis,  acute,  253. 

chronic,  255. 
in  salpingitis,  chronic,  524. 
in  seasickness,  399. 
in  syphilis,  546. 
in  tobacco  habit,  452. 
in  tuberculosis,  273. 
in  urticaria,  555. 
in  variola,  224. 
physiological  action,   150. 
technique,  150. 
temperature  of,   150. 
therapeutics   of,   152. 
with  Japanese,   150. 
tepid,  full,  in  enteritis,  acute,  244. 
in  fever,  scarlet,  216. 
in  typhoid,   199. 
very  hot  full,  150. 
warm   full,   153. 

action  upon  nervous  system,   153. 

apparatus,  153. 

as  diagnostic  agent,  154. 

in  acne.  560. 

in  bladder,  atony  of,  550. 

in  cholera,  Asiatic,  228. 

in  endometritis,  acute,  517. 

chronic,  518. 


604 


INDEX. 


Bath,  warm  full,  in  epilepsy,  378. 

in  fever,  scarlet,  216. 

in  hemorrhage,  cerebral,  347. 

in  leprosy,  576. 

in  measles,  214. 

in  meningitis,    cerebro-spinal,    154. 

in  migraine,  391. 

in  neurasthenia,  366. 

in  neuroses,  occupation,  402. 

in  rachitis,  305. 

in  rearing  of  delicate  child,  503. 

in  urine,  suppression  of,  547. 

in  vertigo,  398. 

physiological  action,   153. 

technique,   153. 

temperature  of,  153. 

therapeutics,  154. 
half,  147. 

apparatus,   147. 

contraindications,   149. 

friction  in,   147. 

in  alcoholic      intoxication,      acute, 
480. 

in  anemia,   149,  313. 

in  anidrosis,  570. 

in  ataxia,  locomotor,  354. 

in  autotoxemia,   149. 

in  bronchitis,   149. 

in  chlorosis,  149. 

in  congestion,  hypostatic,  149. 

in  constipation,  149. 

in  dysentery,  acute,  245. 

in  dysmenorrhea,  515. 

in  epilepsy,  378. 

in  fevers,  149. 

in  hemorrhage,  cerebral,  347. 

in  locomotor  ataxia,   148. 

in  meningitis,   spinal,  chronic,    148. 

in  migraine,  391. 

in  myelitis,  chronic,  148,  351. 

in  nervous      diseases,      functional, 
149. 

in  neurasthenia,    149,   366. 

in  obesity,  304. 

in  neuroses,  occupation,  402. 

in  organic  diseases,  148. 

in  pleuritis,  acute,  278. 

in  priapism,  542. 

in  psychoses,  149. 

in  rearing  of  delicate  child,  503. 

in  rhinitis,  chronic,  255. 

in  spinal  curvature,  584. 

in  spinal  diseases,  organic,   148. 

in  syphilis,  545. 

in  ulcers,  gastric,  241. 

in  vertigo,  398. 

physiological  action,  148. 

technique,  147. 

temperature  of,  147. 

therapeutics  of,  148. 
hot  half,  147. 
horizontal  rain,  184,  598. 

apparatus,   184. 

in  abortion,  521. 

in  acne,  560. 

in  alcoholic      intoxication,      acute, 

480. 
in  alcoholism,  chronic,  493. 


Bath,  horizontal  rain,  in  alopecia,  567. 
in  amenorrhea,'  510. 
in  anemia,  313. 
in  anidrosis,  570. 
in  arterio-sclerosis,  330. 
in  ascites,  282. 
in  asthma,   268. 
in  ataxia,  locomotor,  354. 
in  atony  of  the  bladder,  550. 
in  atony,  gastric,  235. 
in  atony,  intestinal,  235. 
in  bronchitis,  acute,  257. 
in  bronchitis,   chronic,   259. 
in  carbuncle,  565. 
in  cellulitis,  pelvic,   chronic,   528. 
in  chorea,  380. 
in  cirrhosis,  hepatic,  286. 
in  cholelithiasis,  286. 
in  coffee  habit,  454. 
in  comedo,  566. 
in  congestion,  hepatic,  283. 
in  constipation,  248. 
in  dementia  precox,  430. 
in  diabetes  mellitus,  301. 
in  dilatation,  gastric,  235. 
in  dysmenorrhea,  514. 
in  eczema,  557. 
in  emphysema,  269. 
in  endometritis,  chronic,   518. 
in  enuresis,  551. 
in  enteritis,  chronic,  246. 
in  epilepsy,  379. 
in  gastritis,  chronic,  234. 
in  gastro-intestinal   neuroses,  251. 
in  goitre,  exophthalmic,  382. 
in  grippe,  210. 
in  headache,  386. 
in  heart  diseases,  functional,  334. 
in  hemorrhage,  cerebral,  347. 
in  hemorrhage,  uterine,  520. 
in  hemorrhoids,  554. 
in  herpes   simplex,   558. 
in  hyperidrosis,  568. 
in  hypersecretion,  states  of,  239. 
in  hyposecretion,  states  of,  242. 
in  hysteria,  372. 
in  impotence,  541. 
in  insanity,  confusional,  425. 
in  insolation,  414. 
in  insomnia,  395. 
in  jaundice,  catarrhal,  284. 
in  lithemia,  279. 
in  malaria,  213. 
in  mania,   417. 
in  melancholia,  421. 
in  menopause,  532. 
in  migraine,  391. 
in  morphine  habit,  443. 
in  myelitis,  chronic,  352. 
in  nephritis,   chronic,   310. 
in  neuralgia,   342. 
in  neurasthenia,  366. 
in  neuritis,  acute,  336. 

multipre,  340. 

sciatic,  338. 
in  neuroses,  occupation,  402. 

sexual,  543. 
in  oophoritis,  chronic,  526. 


INDEX. 


605 


Bath,  horizontal  rain,  in  orchitis,  535. 
in  paralysis   agitans,   404. 
in  paranoia,  428. 
in  paresis,  434. 
in  pemphigus,   558. 
in  periostitis,  595. 
in  pertussis,  215. 
in  pleuritis,  acute,  279. 
in  priapism,  542. 
in  prostatitis,  chronic,  537. 
in  pruritus  vulvae,  506. 
in  psoriasis,  561. 
in  rectum,  prolapse  of,  553. 
in  rhinitis,   acute,  254. 

chronic,  255. 
in  salpingitis,  chronic,  524. 
in  seasickness,  399. 
in  seborrhea,  572.     ■ 
in  spasm,  facial,  406. 
in  spermatorrhea,   539. 
in  spinal  curvature,  584. 
in  splanchnoptosis,  237. 
in  sprains,  582. 
in  sterility,  530. 
in  surgery,  abdominal,  588. 
in  syphilis,  545. 
in  tobacco  habit,  452. 
in  torticollis,  rheumatic,  409. 
.  in  tuberculosis,  274. 
in  ulcers,  592. 
in  urine,  retention  of,  552. 
in  uterine  displacements,  519. 
in  urticaria,  555. 
in  vaginitis,  508. 
in  vaginismus,  507. 
in  uremia,   311. 
in  vertigo,  398. 
technique,   184. 
hot  air,  74. 
in  acne,  560. 
in  alcoholic      intoxication,      acute, 

480. 
in  anemia,  313. 
in  anidrosis,  569. 
in  ascites,  282. 
in  atony  of  bladder,  550. 
in  atony,  gastric,  235. 
in  atony,  intestinal,  235. 
in  bronchitis,  chronic,  259. 
in  cholelithiasis,  286. 
in  chorea,  380. 
in  congestion,  hepatic,  283. 
in  constipation,  248. 
in  diabetes  mellitus,  301. 
in  dilatation,   gastric,   235. 
in  dysmenorrhea,  514. 
in  enuresis,  551. 
in  enteritis,  chronic,  246. 
in  epilepsy,  378. 
in  gastritis,  chronic,  234. 
in  gastro-intestinal  neuroses,  251. 
in  gout,  296. 
in  headache,  386. 
in  herpes  simplex,  558. 
in  hypersecretion,  states  of,  239. 
in  hyposecretion,  states  of,  252. 
in  hysteria,  372. 
in  jaundice,  catarrhal,  284. 


Bath,  ho!   air,  in  lit luniia,  299. 
in  melancholia,  4_M. 
in  neuralgia,  342. 
in  neuroses,  occupation,  402. 
in  obesity,  304. 
in   paranoia,   428. 

in  pleuritis,  acute,  278. 

in   rhinitis,   chronic,  255. 
in  splanchnoptosis,  237. 
in  surgery,  abdominal,  588. 
in  syphilis,  546. 
in  tuberculosis,  273. 
in  uremia,  311. 
in  vaginismus,  507. 
incandescent    electric  light,  67. 
in  abortion,   521. 
in  acne,  560. 
in  alcoholic      intoxication,      acute, 

480. 
in  alcoholism,  chronic,  493. 
in  alopecia,  567. 
in  amenorrhea,   510. 
in  anemia,  313. 

pernicious,  315. 
in  anidrosis,  569. 
in  appendicitis,  598. 
in  arterio-sclerosis,  330. 
in  arthritis,   rheumatoid,  295. 
in  ascites,  282. 
in  asthma,  268. 
in  ataxia,   locomotor,   354. 
in  atony  of  bladder,  550. 
in  atony,  gastric,  235. 
in  atony,  intestinal,  235. 
in  bronchitis,  chronic,  259. 
in  cardiac  hypertrophy,  328. 
in  cellulitis,  pelvic,  chronic,  528. 
in  chorea,  380. 
in  cirrhosis,  hepatic,  286. 
in  cholelithiasis,  286. 
in  coffee  habit,  454. 
in  comedo,  566. 
in  congestion,  hepatic,  283. 
in  constipation,  248. 
in  delirium,  acute  alcoholic,  484. 
in  dementia  precox,  430. 
in  diabetes  mellitus,  301. 
in  dilatation,  gastric,  235. 
in  dysmenorrhea,  514. 
in  eczema,  557. 
in  emphysema,  269. 
in  endometritis,  chronic,   518. 
in  enuresis,  551. 
in  enteritis,  chronic,  246. 
in  epilepsy,  378. 
in  gastritis,  chronic,  234. 
in  gastro-intestinal   neuroses,  251. 
in  goitre,  exophthalmic,  382. 
in  gout,  295. 
in  headache,  386. 
in  heart  diseases,   functional,  334. 
in  hemorrhage,  cerebral,  347. 

uterine,  520. 
in  hemorrhoids,  554. 
in  herpes,  simplex,  558. 
in  hyperidrosis,   568. 
in  hypersecretion,  states  of,  239. 
in  hyposecretion,  states  of,  242. 


606 


INDEX. 


Bath,     incandescent    electric    light,     in 
hysteria,  372. 
in  impotence,  541. 
in  insanity,  confusional,  425. 
in  insolation,  414. 
in  insomnia,  29*. 
in  jaundice,  catarrhal,  283. 
in  lithcmia,  299. 
in  mania,  417. 
in  melancholia,  421. 
in  menopause,  532. 
in  migraine,  291. 
in  morphine  habit,  443. 
in  myelitis,   chronic,   352. 
in  nephritis,  chronic,  310. 
in  neuralgia,  342. 
in  neurasthenia,  366. 
in  neuritis,  acute,  336. 

multiple,  340. 
in  neuroses,  occupation,  402. 

sexual,  543. 
in  obesity,  304. 
in  oophoritis,  chronic,  527. 
in  orchitis,  535. 
in  paralysis   agitans,  404. 
in  paranoia,  428. 
in  paresis,   434. 
in  pemphigus,  558. 
in  pertussis,  215. 
in  pleuritis,  acute,  278. 
in  priapism,  542. 
in  prostatitis,  chronic,  537. 
in  pruritus  vulvae,  506. 
in  psoriasis,  561. 
in  rectum,  prolapse  of,  553. 
in  rheumatism,  acute  articular,  289. 

muscular,  293. 
in  rhinitis,  acute,  254. 

chronic,  255. 
in  salpingitis,  chronic,  524. 
in  seasickness,  399. 
in  seborrhea,  573. 
in  spasm,  facial,  406. 
in  spermatorrhea,  539. 
in  spinal  curvature,  584. 
in  splanchnoptosis,   237. 
in  sterility,  530. 
in  surgery,  abdominal,  588. 
in  syphilis,  545. 
in  tobacco   habit,  452. 
in  tuberculosis,  274. 
in  ulcers,  592. 
in  urine,   retention   of,   552. 

suppression  of,  547. 
in  uterine    displacements,    519. 
in  urticaria,    555. 
in  vaginitis,   508. 
in  vaginismus,  507. 
in  vertigo,  398. 
hot,  local,  in  sprains,  581. 
mineral,  179. 
at  springs,    179. 
in  arthritis,   rheumatoid,   295. 
in  diabetes  mellitus,   301. 
in  neuritis,   sciatic,  339. 
in  rheumatism,     chronic     articular, 
292. 
Xauheim,  160. 


Bath,    Xauheim,    action    upon    circula- 
tion, 163. 

metabolism,   164. 

nervous  system,   164. 

respiration,  163. 

temperature,    163. 
apparatus,    161. 
chemical    formulae,    161. 
contraindications,   165. 
course  of  baths,   163. 
in  abortion,   521. 
in  angina  pectoris,  332. 
in  arterio-sclerosis,  330. 
in  ataxia,  locomotor,  354. 
in  cardiac   dilatation,    165. 
in     cardiac  disease,   165. 

organic,  327. 

hypertrophy,   328. 

neuroses,    165. 

stenosis,  165. 
in  dilatation,  cardiac,  327. 
in  endocarditis,  acute,   165. 

chronic,  317. 
in  goitre,    exophthalmic,    165,    382. 
in  gout,  165. 
in     heart,   fatty,  328. 
in  locomotor  ataxia,   165. 
in  myelitis,   chronic,   351. 
in  nephritis,  chronic,  310. 
in  obesity,  305. 
in  pelvic  diseases,  165. 
in  pruritus,  573. 
in  rheumatism,  chronic,  165. 
in  urine,  suppression  of,  547. 
in  vascular  disease,   165. 
in  vertigo,  397. 
method  of  grading,  162. 
physiological  action,   163. 
technique,   161. 
temperature  of,  161. 
therapeutics  of,   165. 
with  Triton  salts,  162. 
oxygen,   166. 
apparatus,    166. 
contraindications,   166. 
physiological    action,    166. 
technique,   166. 
temperature,   166. 
neutral,  156. 

action    of    upon    nervous    system, 

156. 
apparatus,   156. 
at  Bethlehem   Hospital,   158. 
in  anemia,    314. 
in  cardiac  hypertrophy,  328. 
in  chorea,   380. 
in  drug  habits,   157. 
in  fevers,  typhus,  230. 
in  hysteria,    158. 
in  insomnia,  395,   157. 
in  mania,  417. 
in  melancholia,  420. 
in  migraine,   391. 
in  miliaria,  571. 
in  morphinism,    157. 
in  nervous      diseases,      functional, 

157. 
in  neurasthenia,   158. 


INDEX. 


go: 


Bath,  neutral,  in  neuritis,  158. 
in  oophoritis,  chronic,  527. 
in  the  overworked,  158. 
in  paranoia,  428. 
in  pemphigus,  558. 
in  pertussis,  215. 
in  pruritus,   158,  573. 
in  psoriasis,  561. 
in  sudamina,  571. 
in  typhoid,   199. 
in  urine,  suppression  of,  547. 
in  urticaria,    555. 
in  varicella,  215. 
in  variola,  224. 
physiological  action,   156. 
technique,  156. 
therapeutics  of,   157. 
cold  plunge,   175. 
apparatus.    175. 
contraindications,    175. 
dangers  of,  175. 
physiological   action,   175. 
technique,   175. 
temperature  of,  175. 
room,  accessories,   110. 
attendant,   112. 
cleanliness  in,  111. 
lockers,    110. 
nurse,   112. 
quiet  in,   113. 
sandals  in,   112. 
scale,  112. 
temperature   of,  99. 
use  of  ice  helmet  in,  113. 
Russian,  74,  81. 
action   upon  blood,  77. 

circulation,  76. 

digestion,  77. 

elimination,  78. 

metabolism,    77. 

muscular   fibre,   77. 

nervous  system,  77. 

respiration,   77. 

temperature,    78. 
Eskimo,  use  of,  75. 
Finns,  use  of,  75. 
in  gout,  296. 
in  lithemia,  299. 
in  rheumatism,     chronic    articular, 

292. 
North    American    Indians,    use   of, 

74. 
physiological    action,    74. 
technique,   82. 
sheet,  118. 
shower,  cold,   180. 

in  bladder,  atony  of,   550. 
in  endometritis,    acute,    517. 

chronic,   518. 
in  menopause,  532. 
in  rearing   of   delicate   child,   503. 
in  salpingitis,   chronic,  524. 
in  syphilis,    546. 
in  vertigo,  398. 
sitz,  143. 

alternating,  146. 
apparatus,   143. 
technique,   143. 


Bath,  mid  siix,  143. 

action  upon  circulation,  144. 

metabolism,  144. 

muscular   system,    144. 

nervous  system,   144. 

temperature,  144. 
i  ontraindications,   145. 
in  abortion,   521. 
in  amenorrhea,   510. 
in  bladder,  atony  of,  550. 
in  bladder,   paralysis,    144. 
in  cellulitis,    pelvic,    chronic,    528. 
in  cirrhosis,   hepatic,  286. 
in  cholera,    Asiatic,   229. 
in  colitis,   145. 
in  constipation,    145,   248. 
in  diarrhea,    145. 
in   dysentery,  acute,   145,  245. 
in  dysmenorrhea,  514. 
in  enuresis,  551. 
in  enteritis,  acute,   145,  243. 

chronic,  246. 
in  hemorrhage,  uterine,  520. 
in  hemorrhoids,   554. 
in  hyperemia,   renal,   306. 
in  hypersecretion,  states  of,  239. 
in  impotence,  541. 
in  insomnia,  396. 
in  jaundice,  catarrhal,  284. 
in  menorrhagia,   145. 
in  neuroses,  sexual,  543. 
in  oophoritis,  chronic,  526. 
in  pelvic  inflammations,  144. 
in  proctitis,   145. 
in  prostatitis,  chronic,   144,  537. 
in  prostatorrhea,    144. 
in  pruritus  vulvae,  506. 
in  sexual   weakness,    144. 
in  spermatorrhea,   144,  540. 
in  sterility,  530. 
in  ulcer,  gastric,  240. 
in  urinary   incontinence,    144. 
in  uterine  displacements,  519. 
in  vaginitis,  508. 
in  vesiculitis,   seminal,   144. 
physiological  action,   143. 
temperature  of,   143. 
therapeutics  of,  144. 
hot  sitz,  146,  515. 

action  upon  circulation,  146. 

metabolism,   146. 

muscular  system,  146. 

nervous  system,   146. 

temperature,    146. 
apparatus,  146. 
in  amenorrhea,    511. 
in  anal  tenesmus,  147. 
in  anus,  fissure  of,  552. 
in  congestion,  pelvic,   529. 
in  cystitis,  548. 
in  dysmenorrhea,   146. 
in  endometritis,   516. 

chronic,  518. 
in  epididymitis,  534. 
in  gonorrhea,  533. 
in  hemorrhoids,   147,  554. 
in  menstruation,    suppressed,    146. 
in  neuralgia,  ovarian,  147. 


608 


INDEX. 


Bath,  hot  sitz,  in  orchitis,  535. 
in  prostatitis,  acute,  536. 
in  pruritus  vulvas,  506. 
in  urine,  retention  of,  551. 
in  vaginismus,   147,  507. 
in  vaginitis,  508. 
in  vesical  catarrh,   147. 
in  vulvitis,  505. 
physiological  action,   146. 
technique,   146. 
temperature   of,   146. 
therapeutics  of,  146. 
to  introduce  catheter,   147. 
neutral  sitz,   143. 

in  endometritis,  chronic,  518. 
in  priapism,  542. 
in  spermatorrhea,   540. 
tepid  sitz,  145. 
shower,   183. 
apparatus,  183. 
in  rhinitis,  acute,  253. 

chronic,  255. 
in  tobacco  habit,  452. 
in  tuberculosis,   273. 
technique,   184. 
sponge,  alkaline,   118. 
in  pruritus,   118. 
in  urticaria,    118. 
sponge,  cold,  115. 
apparatus,  115. 
in  abortion,  521. 
in  acne,   560. 
in  anemia,  313. 
in  amenorrhea,  510. 
in  arterio-sclerosis,  330. 
in  asthma,  268. 
in  bladder,  atony  of,  550. 
in  bronchitis,  acute,  257. 

chronic,  259. 
in  carbuncle,  565. 
in  cardiac   disease,   organic,   327. 
in  cellulitis,  pelvic,  acute,  528. 
in  coffee  habit,  454. 
in  diabetes  mellitus,  301. 
in  diphtheria,  218. 
in  diseases,   chronic,   117. 
in  dysentery,  acute,  245. 
in  emphysema,  269. 
in  endocarditis,   chronic,   317. 
in  endometritis,   acute,   516. 

chronic,  518. 
in  enteritis,  acute,  243. 
in  epilepsy,   378. 
in  erysipelas,  220. 
in  fevers,   116. 
in  fever,  scarlet,  217. 

yellow,  226. 
in  gangrene,  593. 
in  grippe,  211. 
in  headache,  386. 
in  heart  diseases,   functional,  334. 
in  hypersecretion,  states  of,  239. 
in  infections,  septic,  594. 
in  insanity,  confusional,  424. 
in  insolation,  413. 
in  malaria,  212. 
in  mania,  417. 

acute  alcoholic,  488. 


Bath,  sponge,  cold,  in  measles,  214. 
in  melancholia,  420. 
in  meningitis,   344. 
in  menopause,  531. 
in  miliaria,  571. 
in  mumps,  219. 
in  neurasthenia,  365. 
in  neuritis,  sciatic,  338. 
in  neuroses,  occupation,  402. 
in  oophoritis,   acute,   525. 

chronic,  526. 
in  paralysis  agitans,  404. 
in  periostitis,  595. 
in  pertussis,  215. 
in  pneumonia,   265. 
in  psoriasis.  561. 
in  rachitis,  305. 

in  rearing  of  delicate  child,  503. 
in  rhinitis,  acute,  253. 
in  seasickness,  399. 
in  shock,  surgical,  586. 
in  spermatorrhea,    539. 
in  spinal  caries,  585. 
in  spinal   curvature,   584. 
in  sudamina,  571. 
in  surgery,   abdominal,   588. 
in  syphilis,  546. 
in  tobacco  heart,  452. 
in  typhoid,   116,  199. 
in  ulcer,  gastric,  241. 
in  uremia,   311. 
in  urticaria,  555. 
in  vertigo,  398. 
physiological  action   of,   117. 
technique,    115. 
temperature   of,    116. 
sponge,  hot,  117. 
in  fevers.  117. 
steam,   local,  93. 
sweating,  75. 
swimming,    178. 
in  enuresis,   551. 

in  rearing  of   delicate   child,   504. 
evil  effects  of,  178. 
towel,  115. 
Turkish,  74,  80. 

action  upon  blood,  77. 

circulation,   76. 

digestion,   77. 

elimination,   78. 

metabolism,   77. 

muscular  fibre,  77. 

nervous  system,   77. 

respiration,   77. 

temperature,  78. 
application  of,  80. 
in  alcoholism,  chronic,  493. 
in  anidrosis,  569. 
in  bronchitis,  acute,  257. 
in  congestion,  hepatic,  283. 
in  diabetes,   84. 
in  enteritis,  chronic,  246. 
in  gout,  296. 

in  hyperemia,   renal,  306. 
in  lithemia,   299. 
in  menopause,   532. 
in  nephritis,  310. 
in  oophoritis,  chronic,  526. 


INDEX. 


609 


Bath,  Turkish,  in  obesity,  84. 
in  paresis,  434. 

in  rheumatism,    chronic    articular, 
292. 

in  rhinitis,  acute,  253. 
physiological  action.  74. 
technique,  80.  . 

vapor,   in  bladder,  atony   Of,  ioU. 
in  fever,  yellow,  226. 
in  neuroses,  occupation,  402. 
in  obesity,  304. 
in  syphilis,  546. 
Baths,  after  meals,  97. 
electric,  91. 
local.  141. 

during  menstruation,  96. 
mineral,   179. 
in   organic  diseases.  9/. 
sand,  89. 
table  of,  105. 
weight  after,  97. 
Beaumetz,  Dujardin,  9. 
Bed  sores,  159,  573.     r 
bath,  continuous,  159.  o/3. 
causes,  573. 
compress,  hot  in,  573. 
definition,  573. 

treatment,  573.  . 

Biliousness,   283.     See   congestion,   he- 
patic. 
"Black  eye,"  578. 
"Blackheads,"  565. 

Bladder,  action  of  cold  toot  bath  upon, 
142. 
atony  of,  549. 

bath,  horizontal  ram,  ddU. 
hot  air,  550.  . 

incandescent  electric  light,   zM. 
cold  sitz,  550. 
vapor,  550. 
warm  full,  550. 
causes,  549. 
definition,  549. 
douche,  jet,  550. 

perineal,  550. 
rub,  salt,  550. 
shower,  cold,  550. 
sponge,  cold,  550. 
symptoms,  549. 
treatment,  549. 
water  drinking  in,  549. 
catarrh,  hot  sitz  bath  in,  147. 
irritable,  547.     See  cystitis. 
paralvsis  of,  144. 

bath,  cold  sitz  in,  144. 
Blanket    pack,    hot,     139.      See    pack 

blanket. 
Blepharospasm,  405,  409. 
Blocks  of  wood,  hot,  83. 
Blood,  action  of  bath,  full  cold,  upon 
174. 
hot  air  upon,  77. 
Russian  upon,  77. 
pack,  full  wet,  upon.  138. 
sunlight  upon,  65.         < 
superheated  dry  hot  air  upon,  //. 
vapor  cabinet  upon,  77. 
water   drinking  upon,   o6. 


Ulood,   diseases  of,  306. 

physiological  action  oi  cold  upon, 
'  48. 

heal  upon,  48. 
hydrotherapy  upon.  47. 
es  of,  316. 
organic  disease,  treatment  of,  31/. 
"Bloody   flux."      See  dysentery,  acute. 
Boils,  563.     See  furuncle. 
Bottle,  hot  water,  85. 
Bouchard,  A.,  69,  174. 
Boulimia,  250. 
Bocker,  8. 
Brachycardia,  2<?>2. 
causes,  333. 
treatment,  ii?>. 
Brain,  diseases  of,  336. 
Bran  bag.  hot,  85. 
Brand,   Ernest,  8,  26,  52,  60,   166,   198, 

202. 
Breitenstein,   174. 
Bricks,  hot,  85. 
"Bri£rht's"  disease,  acute,  307. 
Brunton,  T.  Lauder,  454,  456. 
Broadbent,  486. 
Bronchitis,  acute,  257. 
bath,  half,  257. 

horizontal  rain,  257. 
Turkish,  257. 
causes,  257. 
definition,  257. 
diet,  257. 
hvgiene,  257. 
pack,  full  dry.  257. 

full  wet,  257. 
sponge,  cold,  257. 
steam   inhalation,  257. 
superheated  dry  hot  air,  2o7. 
treatment,  257. 
water  drinking,  257. 
Bronchitis,   capillary,  258. 
bath,  hot  full  153. 
mustard,  258. 
Bronchitis,  chronic.  2d9. 
bath,  horizontal  rain,  2o9. 
hot  air.  259.  . 

incandescent  electric  light,  £39. 

causes,  258. 

compress,  stimulating,  1Z8. 

definition,   258. 

diet,  258. 

douches  in,  192. 

hygiene,  258. 

pack,  full  dry,  259. 

nil),  oil.  259. 

salt.  259. 
sponge,  cold,  259. 
treatment,  259. 
water  drinking,  259 
,       Bronchitis,    fibrinous,   2o8.      See   bron- 
chitis, chronic. 
Bronchorrhea,  Chapman's  ice  bags  in, 

87. 
Brown,  Philip  King.  266 
Bulbar  paralysis,  acute,  34/,  ,54b.     ^>ee 

myelitis. 
Bull,  Farnese,  4. 
Burns,   160,  562. 


610 


INDEX. 


Burns,  bath,  continuous,  in,  563. 
local  warm,  142. 
complications,  562. 
compress,  cool,  563. 
definition,  562. 
treatment,   562. 
varieties,  562. 

Cabinet,  hot  air,  74. 
hot  air  apparatus,  79. 
construction,   79. 
technique,  80. 
vapor,  74. 
Cabot,  R.  C,  200. 
Cachexia,  malarial,  213. 
Caisson   disease,   347,  348.     See  myel- 
itis, acute. 
Calculi,  biliary,  285.   See  cholelithiasis. 
Calidarium,  3. 
Cantana,  B.,  228. 
Caracalla,  thermse  of,  3. 
Carbonated     water,    the    drinking    of, 

59. 
Carbuncle,  564. 

bath,  horizontal  rain,  565. 
causes,  564. 
definition,  564. 
fomentation,  565. 
pathology,  564. 
sponge,  cold,  565. 
symptoms,  564. 
superheated  dry  hot  air,  564. 
treatment,  564. 
Cardiac  diseases,  316. 
collapse,  332. 
bag,  ice,  334. 
causes,  332. 
fomentation.  334. 
treatment,  334. 

in   typhoid,  208. 
water   drinking,   334. 
dilatation,  bath,  Nauheim,  in,   165. 
disease,  ice  bag,  126. 

bath,  Nauheim,  165. 
disease,  chronic,  326. 
organic,  319. 
action  of  cold  in,  319. 
hydrotherapy  in,  320. 
Nauheim  bath  in,  319. 
aims  of  treatment,  318. 
bag,  ice,  327. 

bag,  Chapman's  spinal  ice,  327. 
hath,  Nauheim,  in,  327. 
causes,  326. 
contraindications,    321. 
definition,   326. 
diet,  326. 
disease,  organic,  317. 
drug  action  in,  318,  319. 
exercises  in,  321. 

Oertel's  in,  324. 
hygiene  in,  326. 
principles  of  treatment,  318. 
prognosis,  318. 
sheet,  dripping,  327. 
sponge,  cold,  327. 
treatment,  317,  326. 
hygienic,  321. 


Cardiac  disease,  rules  of,  320. 

failure,   treatment,    in    insanity,   con- 
fusional,  424. 
hypertrophy,  328. 
bag,  ice,  328. 

bath,   incandescent  electric  light, 
328. 
Nauheim,  328. 
neutral,  328. 
neuroses,  Nauheim  bath  in,  165. 
stenosis,  Nauheim  bath  in,  165. 
Cardiospasm,  250. 
Caries,  spinal,  584. 
"Catching     colds,"     hydrotherapy     in, 

101. 
Catarrh,  acute  intestinal.  See  enteritis, 

acute. 
Catarrh,  chronic  intestinal.  See  enteri- 
tis, chronic. 
Cannabis  indica  habit,  435. 
Cellulitis,  pelvic,  acute,  527. 
bag,  ice,  528. 
causes,  527. 
definition,  527. 
diet,  528. 

douche,  vaginal,  528. 
enema,  528. 
fomentation,  528. 
hygiene,  528. 
pathology,  527. 
sponge,  cold,  528. 
symptoms,  527. 
treatment,  528. 
Cellulitis,  pelvic,  chronic,  528. 
bag,  ice,  529. 
bath,  horizontal  rain,  528. 

incandescent  electric  light,  528. 
cold  sitz,  528. 
compress,  stimulating,  528. 
douche,  fan,  528. 

jet,  528. 
fomentation,  528. 
pack,  half  wet,  528. 

pelvic,  528. 
superheated  dry  hot  air,  528. 
Cephalic  compress,  131. 
apparatus,  131. 
temperature  of,  131. 
therapeutics  of,  131. 
Cerebral    apoplexy,    344.      See    hemor- 
rhage, cerebral, 
coil  cap,  85. 

action  upon  temperature,  85. 
in  meningitis,  85. 
congestion,   126. 

cold  compress  in,  126. 
cooling  compress  in,  126. 
bath,  cold  foot,   142. 
embolism,  344,  345.  See  hemorrhage, 

cerebral, 
hemorrhage,    344.      See    hemorrhage, 

cerebral, 
hyperemia,  410. 
paralysis,    superheated    dry    hot    air 

in,  84. 
thrombosis,    344,    345.      See    hemor- 
rhage, cerebral. 
Cerebri,  tinnitus,  396.     See  vertigo. 


ix  dux. 


611 


Chaldeans,  I. 
Chapman,  John,  9,  85. 

hot  water  bag,  86. 
ice  bags,  86. 
pathology,  87. 
technique.  87. 
theorv,  86. 
Charcot,  369. 
Chest,  diseases  of,  253. 
Chicken  pox,  214.     See  varicella. 
Child,  rearing  of   delicate,  499. 
neuropathic,  499. 
tubercular,  499. 
affusion,  503. 
bath,  warm  full,  503. 
half,  503. 
shower,  cold,  503. 
sponge,  cold.  503. 
swimming,  504. 
surf  bathing,  504. 
Chloral  habit,  435. 
Chlorosis,  312.     See  anemia, 
bath,  half,  149.  . 

incandescent  electric  light,  /t. 
douches  in,   192. 
sheet,  dripping,  120. 
sunlight  in,  6_7. 
Cholangitis,  285.         .    ,      .        OQ-    <~ 
Cholecystitis,  acute,  infective,  283.   bee 

cholelithiasis. 
Cholelithiasis,  285. 
attack,  treatment  of,  285. 
bath,  horizontal  rain,  286. 
hot  air,  286.  . 

incandescent  electric  light,  28b. 
causes,  285. 

compress,  hot  trunk,  28o. 
definition,  285. 
douche,  fan,  286. 

jet,  286. 
fomentation,  285. 
hygiene,  286. 
sheet,  dripping,  286. 
treatment,  285. 
water  drinking,  285. 
Cholera,  Asiatic,  227. 
bath,  cold  sitz,  229. 

warm   full,  228. 
causes,  227. 
definition,  227. 
diet,  227. 
hygiene,  227. 
mortality,  227^ 
pathology.  227. 
sheet,   dripping,   229. 
symptoms,  227. 
treatment,  227.  .  . 

Cholera   infantum.   See   enteritis,  acute 
nostras,  229. 
cause,  229. 
definition,  229. 
hygiene,  230. 
mortality.  230. 
symptoms,  230. 
treatment,  230. 
Chorea,  379. 

bath,  horizontal   ram.  38U. 
hot  air.  380. 


Chorea,     bath,     incandescent     electric 
light  in,  74,  380. 

neutral,  380. 
causes,  379.  _ 
definition,  379. 

douche,  fan,  380. 
mortality,  380. 
pack,    full    wet,   380. 
prognosis,  380. 
sheet,  dripping,  380. 
treatment,   380. 
Chronic    diseases,    pack,    full    wet,   in, 

138. 
Church  and  Peterson,  427.  , 

Circular  bath,  184.    See  bath,  horizon- 
tal rain. 
Circulation,   action   of   bath,   cold    full, 
upon,  170. 
hot  full,  upon,  150. 
Xauheim,  upon.  163. 
cold  sitz,  144. 
hot  sitz,  upon,  146. 
Turkish,  upon,  76. 
Chapman's  hot  water  bags  upon,  8/. 

ice  bags  upon,  87. 
douches,  cold,  upon,  189. 

hot,  upon,  18S. 
hot  air  upon,  76. 
pack,  full  wet,  upon,_136. 
Russian  bath  upon,  76. 
superheated  dry  hot  air  upon,  /b. 
vapor  cabinet  upon,  76 
water  drinking  upon,  ^6. 
physiological  action  of  heat  upon,  2/. 
cold  upon,  28. 
Cirrhosis,   hepatic,  286. 
bath,  arc  light,  286. 
horizontal  ram,  286. 
incandescent  electric  light,  280. 
cold  sitz.  286. 
causes,  287. 
definition,   286. 
diet,  286. 
douche,  fan,  286. 
jet,  286. 
Scottish.  287. 
hygiene,  286. 
treatment,  286. 
water  drinking,  286 
Clark,  Sir  Andrew.  303,  Ol-J. 

and  dishing,  199 
Classification   of  baths,  authors,    llo. 
of  compresses,  124. 
of  temperature-.  22. 
Cleansing  action  of   water,   1_. 
bath,  155. 

apparatus,  155. 
dangers  of,  155. 
frequency,   155. 
technique,   155. 
temperature^  of,  155. 
uses  of,  15o. 
"Clergyman's    sore    throat.     _o4.      bee 

rhinitis,   chronic. 
Climacteric,  530. 
Clouston,  T.  S.,  416. 
Cocaine  habit,  435. 
Coffee  habit,  453. 


612 


IXDEX. 


Coil,  Leiter,  123. 
hot  water,  85. 
cap,  cerebral,  85. 
Coile  bed   bath,    167.     See  bath,   Coile 

bed. 
Cold  hands,  574. 
Cold    plunge    bath.      See    bath,    cold 

plunge. 
Colic,  fomentation  in,  122. 
intestinal,   250. 

water  drinking,  hot  in,  61. 
hepatic,  285.     See  cholelithiasis, 
renal,  312. 

bath,  hot  full,  312. 

causes,  312. 

definition,  312. 

diet,  312. 

fomentation,  312. 

hygiene,  312. 

treatment,  312. 

water  drinking,  312. 
Colitis,  acute.     See  dysentery,  acute, 
chronic.     See  enteritis,  chronic. 

bath,  cold  sitz  in.  145. 
compress,  stimulating,  128. 
Comedo,  565. 
bath,  horizontal  rain,  566. 

incandescent  electric  light,  566. 
causes,  565. 
compress,  hot,  566. 
definition,  565. 
diet,  566. 
fomentation,  566. 
pathology,   565. 
superheated  dry  hot  air,  566. 
treatment,  566. 
Compresses,  123. 

classification  of,  124. 
Compress,  abdominal,  214. 
in  cold  feet,  574. 
in  gastritis,  acute,  233. 
in  gastro-intestinal  neuroses,  251. 
in  variola,  224. 

hot,  abdominal,  in  ulcer,  gastric,  240. 
cephalic,  131. 

in  hemorrhage,    cerebral,    346. 
chest,    132,  214. 

apparatus,   132. 

in  congestion,  pulmonary,  260. 

in  edema,   pulmonary,   261. 

in  pneumonia,  263. 

in  tuberculosis,   273. 

technique,  132. 

temperature  of,   132. 

therapeutics   of,   133. 
cold,  in  acne,  560. 

in  asthenopia,  578. 

in  contusions,  580. 

in  dermatitis,  562. 

in  erysipelas,  220. 

in  eyeball,  diseases  of,  578. 

in  fever,  yellow,   226. 

in  gonorrhea,  534. 

in  gout,  295. 

in  hemorrhage,  586. 

in  insolation,  412. 

in  laryngitis,  croupous,  256. 

in  miliaria,   571. 


Compress,  cold,  in  mumps,  219. 

in  pericarditis,   316. 

in  rhinitis,  chronic,  255. 

in  sudamina,  571. 

in  typhoid,   199. 
cold  and  cooling,  124. 

in  cerebral  congestion,  126. 

in  fever,  delirium  of,  126. 

in  headache,  126. 

in  hemorrhoids,    126. 

in  inflammations,   125. 
throat,  126. 

in  joint  diseases,   126. 

in  mania,    126. 

in  meningitis,  126. 

in  orchitis,   126. 

in  typhoid  fever,   126. 

in  wounds,  126. 

physiological    action,    124. 

therapeutics  of,   125. 

to  prevent  retrostasis,   126. 
cooling,  in  burns,  563. 

in  eczema,  567. 

in  fever,  surgical,  587. 

in  infection,  septic,  593. 

in  synovitis,  acute,  590. 
hot,  124,  129. 

in  bed  sores,  573. 

in  cholelithiasis,  285. 

in  comedo,  566. 

in  hemorrhage.  586. 

in  herpes  zoster,   559. 

in  neuritis,  multiple,  340. 

in  rhinitis,  chronic.  255. 

in  torticollis,  rheumatic,  409. 
joint,  134. 

neutral,  in  herpes  zoster,  559. 
stimulating,  124. 

in  alopecia,  567. 

in  appendicitis,  128.  595. 

in  arthritis,   rheumatoid,   294. 

in  asthma,  267. 

in  bronchitis,  chronic,  12S. 

in  cellulitis,  pelvic,   chronic,  528. 

in  colitis,   128. 

in  contusions,  580. 

in  dislocations,  583. 

in  epididymitis,  534. 

in  enteritis,   128. 

in  exudates,    12S. 

in  fever,  surgical.  587. 

in  gastritis,  128. 

in  gout,  296. 

in  hepatitis,  128. 

in  jaundice,  catarrhal,  284. 

in  orchitis,  535. 

in  peritonitis,  acute,  128,  280. 

in  pleuritis,  acute.  278. 

in  pneumonia,  128. 

in     rheumatism,     acute     articular, 
128,  290. 
chronic  articular,  128,  292. 

in  salpingitis,  chronic,  524. 

in  seborrhea,  573. 

in  synovitis,   chronic,   590. 

in  throat  inflammations,   128. 

in  tonsillitis,   128. 

in  ulcers,   128. 


INDEX. 


613 


Compress,     stimulating,     physiological 
action,  127, 

therapeutics  of,  128. 
throat.   131. 

in  diphtheria,  218. 

in  laryngitis,   spasmodic,  256. 

in  measles,  214. 

in  rhinitis,  acute,  254. 
trunk,   133. 

apparatus,  133. 

in  ascites,  2X2. 

in  endometritis,    acute,    516. 

in  hemorrhage,  cerebral,  346. 
uterine.   521. 

in  myelitis,  acute,  350. 

in  oophoritis,  chronic,  527. 

in  surgery,  abdominal,  588. 

technique  of,  133. 

temperature  of,  133. 
Confusional   insanity,   422. 
Congestion,  hepatic,  283. 

bath,  horizontal  rain,  283. 
hot  air,  283. 

incandescent   electric  light,  283. 
Turkish,  283. 

causes,  2*3. 

definition,  283. 

diet,  283. 

douche,  fan,  283. 
jet,  283. 

fomentation,  283. 

hygiene,  283. 

treatment,  283. 
hypostatic.  149,  260.     See  congestion, 
pulmonary. 

half  bath  in,  149. 
pelvic,  529. 

bag,  ice,  529. 

bath,  hot  sitz,  529. 

causes,  529. 

definition,  529. 

douche,  vaginal,  529. 

treatment,  529. 
pulmonary.  260. 

bag,  Chapman's  hot  water,  260. 

bath,  hot"  foot,  260. 

causes,  260. 

compress,  chest,  260. 

definition.  260. 

fomentation,  260. 

pack,  half  dry,  260. 
half  wet,  2*60. 

treatment,  260. 
Constipation,  247. 

bag,   Chapman's   ice,  87. 
bath,  half.  149.      - 

horizontal  rain,  248. 

hot  air,  248. 

incandescent  electric  light,  248. 

cold  sitz.  145,  248. 
causes.  247. 
definition,  247. 
diet.  247. 
douche,  fan,  248. 

jet.  248. 

perineal.  249. 

Scottish,  248. 
hygiene,  247. 


sheet,  dripping,  in,  24S. 
treatment,  247. 
in  typhoid,  208. 
water  drinking,  247. 
Construction    of    hydrotherapeutic    in- 
stitution. 109. 
Continuous  bath,   15.S.     See  bath,  con- 

tinui 
Contraindications  of  baths,  cold,  97. 
of  bath,  cold  foot,  142. 
hot  full,   153. 
half,  149. 
cold  plunge,  175. 
Nauheim,  165. 
oxygen,   166. 
cold  sitz,  145. 
cold  water  drinking,  61. 
of  douches.  193. 
in  cardiac  disease,  organic,  321. 
of  fomentation,  123. 
of  hydrotherapy,  53. 
of  pack,  full  dry,  140. 
of  pack,  full  wet,  139. 
of  sheet,   dripping,    120. 
of  surf  bathing,  178. 
Contusions,  580. 
bath,  hot  foot.  141. 
causes,  580. 
compress,  cold,  580. 

stimulating,  580. 
definition,  580. 
fomentation,  580. 
pathology,  580. 

sponge,  alternate  hot  and  cold,  580. 
symptoms,  580. 
treatment,  508. 
Convalescence    in    typhoid,    treatment, 

208. 
Convulsions,    infantile,    bath,    hot    full, 
153. 
puerperal.    522.      See    eclampsia. 
Cool,  how  to  keep,  571. 
Cooling  room,  in  hydrotherapeutic  in- 
stitutions, 109. 
Copralalia,  409. 
Cornea,  inflammation  of,  578. 
ulceration  of,  578. 
wounds  of,  578. 
Cramp,  writer's,  4C0. 
Craving,    treatment    of,    in    alcoholism, 

chronic,  494. 
Croftan,  A.  C,  301,  309. 
Croup,   catarrhal,   256.     See   laryngitis, 

spasmodic. 
Currie,  James,  6,  8.  183. 
Curvature,  spinal,  583.     See  spinal  cur- 
vature. 
Cushiner.  593. 

and  Clark,   199. 
Cushney,  463. 
Cyclitis,  578. 
Cystitis,  547. 

bath,  continuous,  5 

hot  sitz,  548. 
causes,  547. 
definition,  547. 
diet,  547. 
enema,  547. 


614 


IXDEX. 


Cystitis,  fomentation  in,   122.  547. 
water  drinking,  547. 

DaCosta,  J.  M.,  331. 
Dana,  C.  L.,  341,  342,  356.  362,  363,  370, 
403,  409,  423,  427,  431,  433,  457. 
Delafield,  F,  202. 

Delirium,  treatment,  in  typhoid,  207. 
acute,  422. 
acute  alcoholic,  484. 
bag,  ice,  485. 
bath,  hot  full,  484. 

incandescent   electric   light,  484. 
definition,  480. 
diagnosis,  482. 
hallucinations  of,  481. 
insomnia  of,  481. 
pack,  full  wet,  486. 
wet  blanket,  485. 
progriosis,  482. 
restraint  in,  485. 
temperature,  481. 
treatment,  483. 
symptoms,  480. 
water  drinking  in,  484. 
febrile,  422. 
tremens,  457.  480. 
Dementia,  acute,  422. 
paralytic,  431. 
paretic,  431. 
precox,  428. 

bath,     incandescent    electric    light, 
430. 
horizontal  rain,  430. 
causes,  429. 
definition,  428. 
hygiene,  430. 
prognosis,  430. 
symptoms,  428. 
treatment,  430. 
primary,  422. 
Dengue  fever,  213.     See  fever,  dengue. 
Denuce,  589. 
Dermatitis,  562. 
compress,  cold,  562. 
definition,  562. 
pathology,  562. 
treatment,  562. 
varieties,  562. 
Dettweiler,  273. 
DeQuincy,  Thos.,  435,  437. 
Diabetes,  sunlight  in,  67. 
bath,  Turkish  in,  84. 
mellitus,  299. 

bath,  horizontal  rain,  301. 
hot  air,  301. 

incandescent   electric  light,  301. 
mineral,  301. 
causes,  299. 
definition,  299. 
diet.  299. 
douche,   fan,   301. 

jet,  301. 
hygiene,   301. 
pack,  full  dry,  301. 
pruritus,  neutral  bath   in,  302. 
sheet,   dripping,   301. 
sponge,  cold,  301. 


Diabetes  mellitus,  symptoms,  300. 
superheated  dry  hot  air,  301. 
treatment,  300. 
insipidus,  302. 
causes,  302. 
definition,  302. 
treatment,   302. 
Diarrhea,  bath,  cold  sitz,  in,  145. 
sheet,  dripping,  in,  120. 
treatment  of  in  typhoid,  207. 
acute.     See  enteritis,  acute, 
chronic.     See  enteritis,  chronic, 
summer.     See  enteritis,  acute. 
Diathesis,  uric  acid,  bath,  incandescent 
electric  light  in,  73.     See  lith- 
emia. 
treatment  of,  299. 
Digestion,   action   bath,    hot   air,   upon, 
77. 
Russian  upon,  77. 
Turkish  upon.  77. 
vapor   upon,   77. 
superheated  hot  air  upon,  77. 
water  drinking  upon.  ST. 
Digestive  diseases,  douche-  in.  192. 
Dilatation,  cardiac,  327. 
bag,  ice,  327. 
bath,  Xauheim,  327. 
causes,  328. 
hygiene,  328. 
symptoms,  327. 
treatment,  328. 
Diphtheria,  218. 
bath,  hot  full.  218. 
cardiac   collapse,   treatment,  218. 
cardiac  lesions,  treatment,  221. 
cause,  218. 

compress,  throat,  218. 
convalescence,  treatment.  219.  221. 
definition,  218. 
delirium,  treatment,  221. 
diet,  218. 
fomentation,  218. 
hygiene,  218. 
mortality,  218. 
nephritis,  treatment,  219. 
neuritis,  treatment,  219. 
sponge,  cold,  218. 
symptoms,  218. 
treatment,  218. 
water  drinking,  218. 
Dipsomania,  458,  496. 
Diseases,  infectious,  194. 

mental,  415. 
Dislocations,  582. 
bag,  ice,  583. 
bath,  hot  full.  582. 
causes,  582. 

compress,  stimulating,  583. 
definition.  582. 
fomentation,  123,  582. 
.   symptoms,  582. 
treatment,  582. 
varieties,  582. 
Displacements,  uterine,  519. 
Disseminated   sclerosis,   353,   360.      See 

ataxia,  locomotor. 
Douche,  180. 


INDEX 


615 


Douche,  definition,  180. 

apparatus,  author's,  182. 
Baruch's,  182. 

reaction    from.    lv7. 
room     in     hydrotherapeutic     institu 

tions,  109. 
fan,  185. 

apparatus.   185. 

in  acne,  560. 

in  alopecia,  567. 

m  anemia,  313. 

mi  anidrosis,  570. 

in  ankylosis,  592. 

in  appendicitis,   598. 

in  alcoholism,  chronic,  494. 

in  asthma,  268. 

in  atony,  gastric.  235. 

intestinal,  235. 
in  cellulitis,    pelvic,    chronic,    528. 
in  cholelithiasis,   286. 
in  chorea,  380. 
in  cirrhosis,   hepatic,   286. 
in  congestion,    hepatic,   283. 
in  constipation,   248. 
in  diabetes  mellitus,  301. 
in  dilatation,   gastric.   235. 
in  eczema,    557. 
in  emphysema,  269. 
in  enuresis,   551. 

in  gastro-intestinal    neuroses,    251. 
in  grippe,  211. 
in  headache,  386. 

in  heart    diseases,    functional,   335. 
in  herpes,  simplex,  559. 
in  hyperidrosis,    568. 
in  hypersecretion,  states  of,  239. 
in  hyposecretion,   states   of,   242. 
in  hysteria,   372. 
in  insanity,   confusional,  425. 
in  insomnia,  393. 
in  jaundice,  catarrhal,  285. 
in  morphine   habit,  443. 
in  myelitis,  chronic,  352. 
in  neurasthenia,  366. 
in  obesity,  304. 
in  pleuritis,  chronic,  279. 
in  pruritus,  573. 
in  psoriasis,   561. 
in  seborrhea,    572. 
in  spermatorrhea,   .r 
in  spinal  curvature.  584. 
in  splanchnoptosis,   237. 
in  syphilis,  545. 
in  vertigo,  398. 
technique,   185. 
jet,  184,  187. 
apparatus,   187. 
in  acne,  560. 
in  alcoholic  acute. 

480. 
in  alcoholism,   chronic.   494. 
in  alopecia,  567. 
in  anemia,  313. 
in  anidrosis,   570. 
in  appendicitis,  598. 
in  atony,  gastric,  235. 

intestinal,   235. 
in  bladder,  atony  of,  550. 


xli 


Douche,  jet,  in  cellulitis,  pelvic,  chronic, 
528. 
in  cholelithiasis,  286. 
in  cirrhosis,  hepatic,  286. 
in  coffee  habit,  454. 
in  congestion,   hepatic,  2^?>. 
in  constipation,  248. 
in  diabetes  mellitus,  301. 
in  dilatation,   gastric,  235. 
in  dysmenorrhea,    514. 
in  eczema,   557. 
in  endometritis,  chronic,  518. 
in  enuresis,  551. 
in  epilepsy,  379. 
in  gastritis,   chronic,  234. 
in  gastro-intestinal    neuroses,   251. 
in  goitre,   exophthalmic. 
in  grippe,  211. 
in  headache,   386. 

in  heart    diseases,    functional,    335. 
in  herpes,  simplex,  559. 
in  hyperidrosis,   568. 
in  hypersecretion,    states    of,    239. 
in  hyposecretion,  states  of,  242. 
in  hysteria,  372. 
in  impotence,  541. 
in  insanity,   confusional.   425. 
in  insolation,  414. 
in  insomnia,  395. 
in  jaundice,   catarrhal,   285. 
in  lithemia,  299. 
in  malaria,  213. 
in  melancholia,  421. 
in  menopause.  532. 
in  migraine,  391. 
in  neurasthenia,    366. 
in  neuroses,    sexual,    543.. 
in  obesity,  304. 
in   oophoritis,  chronic.   527. 
in  orchitis,  535. 
in  paresis.  434. 
in  periostitis,  595. 
in  priapism,  542. 
in  rhinitis,  acute,  254. 

chronic,  255. 
in  seasickness,  400. 
in  seborrhea,  572. 
in  spasm,  facial,  406. 
in  spermatorrhea,   540. 
in  spinal   curvature,   584. 
in  splanchnoptosis,  237. 
in  sterility,  530. 
in  syphilis,  545. 
in  tobacco  habit,  452. 
in  tuberculosis.  274. 
in  urine,  retention  of,  :'-. 
in  urticaria.   555. 
in  vaginismus,   507. 
in  vertigo,  398. 
technique,    187. 
perineal,  in  anal  fissure,  552. 
apparatus,   J85. 
in  bladder,  atony  of.  550. 
in  constipation,  249. 
in  dysmenorrhea,  514. 
in  hemorrhoids,  554. 
in  impotence,  541. 
in  prostatitis,  chronic,  537. 


616 


INDEX. 


Douche,  perineal,  in  pruritus  vulvae,  506. 
in  rectum,  prolapse  of,   553. 
in  spermatorrhea,  540. 
in  vaginismus,  507. 
technique,  185. 
cold  plantar,  in  splanchnoptosis,  237. 
Scottish,  185. 
apparatus,  185. 
in  amenorrhea.  510. 
in  ankylosis,  592. 
in  arthritis,    rheumatoid.    294. 
in  ascites,  282. 
in  cirrhosis,  hepatic,  2X7. 
in  constipation,  248. 
in  eczema,  557. 
in  emphysema,   269. 
in  feet,  cold,  574. 
in  gout.  296. 
in  grippe,  211. 
in  hyperidrosis,   569. 
in  hysteria,  372. 
in  malaria.  213. 
in  neuralgia,  242. 
in  neurasthenia,  366. 
in  neuritis,  sciatic.  339. 
in  pleuritis,  chronic,  279. 
in  psoriasis,  561. 
in  rheumatism,    chronic,    articular, 

293. 
in  rheumatism,  muscular,   293. 
in  spermatorrhea.  540. 
in  spinal  curvature,  584. 
in  sprains,   582. 
in  synovitis,  chronic,  590. 
in  torticollis,  rheumatic.  409. 
in  ulcers,  593. 
technique,  186. 
temperature  of,  186. 
Scottish    fan.    in    gastritis,    chronic, 

234. 
vaginal,  in  amenorrhea,  511. 
cellulitis,  pelvic,  acute,  528. 
in  congestion,  pelvic,   529. 
in  dysmenorrhea,  514. 
in  endometritis,   chronic,   518. 
in  gonorrhea,  534. 
in  hemorrhage,  uterine,  520. 
in  oophoritis,  acute,  525. 

chronic,  526. 
in  pruritus  vulvae,  506. 
in  salpingitis,  acute,  524. 
subacute,  524. 
chronic,  524. 
in  sterility,  530. 
in  vaginitis,  508. 
Douches,  180. 

classification,  182. 

contraindications,   193. 

factors  of.  188. 

for  the  dissipated.  192. 

in  alcoholism,   193. 

in  anemia,  192. 

m  ataxia,  locomotor.  355. 

in  bronchitis,  chronic,  192. 

in  chlorosis,  192. 

in  digestive  diseases,  192. 

in  hysteria,  192. 

in  "liver  trouble,"  192. 


Douches  in  melancholia,  192. 
in  myositis,  192. 
in  nervous      disease-.      functional, 

192. 
in  neuralgia,   192. 
in  neurasthenia,  192. 
in  neuritis,   192. 
in  pleurisy,  192. 
in  pneumonia,    192. 
in  psychoses,  192. 
in  rheumatism,   chronic,    192. 
in  sciatica,  192. 
in  the  sedentary,  192. 
cold,  action  upon  circulation,  189. 
metabolism,  190. 
muscular  system,   191. 
nervous  system,  190. 
respiration,  190. 
temperature,    189. 
in  disease,  chronic,   192. 
physiological  action,  189. 
therapeutics  of,  192. 
hot,  action  upon  circulation,  188. 
metabolism,  188. 
nervous  system,   189. 
respiration,  188. 
temperature,  188. 
physiological  action.  188. 
temperature  of,  188. 
therapeutics   of,   189. 
Dropsy,  281.     See  ascites, 
water   drinking  in,  60. 
Drug  habits,  435. 

bath,  neutral,  in,   157. 
pack,  wet,  in,  138. 
Drunkenness,  457.  477. 

chronic,  457,  489. 
Dry  pack,   full.     See  pack,   full  dry. 
Dressing     rooms     in     hydrotherapeutic 

institutions,  108. 
Duodenal   ulcer.     See   ulcer,   duodenal. 
Duque,  Matias,  575. 
Dysentery,  acute,  244. 
bath,  half.  245. 
hot  foot,  245. 
cold  sitz,  145,  245. 
causes,  244. 
definition,  244. 
diet,  245. 
enema,  245. 
hygiene,  245. 
pack,  hot  dry,  245. 

wet,  245. 
sheet,  dripping,  120,  245. 
sponge,  cold,  245. 
symptoms,  245. 
treatment.   245. 
chronic.     See  enteritis,  chronic. 
Dysmenorrhea,  511. 
bath,  half,  515. 

horizontal  rain,  514. 
hot  air,  514. 
hot  full,  515. 

incandescent  electric  light,  514. 
cold  sitz,  514. 
hot  sitz,  146,  515. 
causes,  512. 
classification,  511. 


INDEX. 


617 


Dysmenorrhea,  definition,   511. 

douche,  jet,  514. 
perineal,  514. 
vaginal,  514. 

enema,  515. 

fomentation,  122,  515. 

hygiene,  514. 

pack,  pelvic,  515. 

pathology,  512. 

symptoms,   513. 

treatment,   514. 

water  drinking,  515. 
Dyspepsia,  chronic,  sunlight  in,  67. 
superheated  dry  hot  air  in,^84. 

nervous.     See  neurasthenia,  361. 

Earache,  578. 

compress,  hot,   130. 
Ear,  diseases  of,  555,  579. 
Ebstein,  303. 
Echokinesis,  409. 
Echolalia,  409. 
Eclampsia,  520. 
bath,  hot   full,  522. 
causes,  522. 
definition,  522. 
enema,  522. 
hygiene,  522. 
mortality,  522. 
pack,  full  dry,  522. 
pathology,  522. 
symptoms,  522. 
treatment.  522. 
Eczema,  556. 

bath,  continuous,  557. 
horizontal  rain,  557. 
incandescent  electric  light,  557. 
causes,  556. 
compress,  cooling,  557. 
definition,  556. 
diet,  556. 
douche,  fan,  557. 
jet,  557. 
Scottish,  557. 
fomentation,  557. 
location,  556. 
pathology,  556. 
surf  bathing,  557. 
treatment,  556. 
water  drinking,  557. 
Enuresis,  550. 

bath,  cold  foot,  551. 
horizontal  rain,  551. 
hot  air,  551. 

incandescent  electric  light,  551. 
cold  sitz,  551. 
swimming,  551. 
causes,  550. 
definition,  550. 
douche,  jet,  551. 
prognosis,  550. 
sheet,  dripping,  551. 
sponge,  hot  and  cold  to  spine,  551. 
surf  bathing,  551. 
nocturna,  550. 
Edema,  angio-neurotic,  556. 
pulmonary,  260. 
bag,  ice,  261. 


Edema,  bath,  hot   Foot  in,  261. 
causes,  261. 
compress,  chest,  261. 
definition,  260. 
diet,  261. 
hygiene,   261. 
mortality,  260. 
pack,  hot   dry,  261. 
treatment,   26l. 
Effervescent  bath,  160.  See  bath,  Xau- 

heim. 
Egyptians,   1. 

Elimination,     action     bath,     cold     full, 
upon,  173. 
hot  air,  upon,  7<X. 
hot   full,   upon,   151. 
Russian,  upon,  78. 
sitz,  cold,  upon,  144. 
superheated  dry  hot  air,  upon,  78. 
Turkish,  78. 
vapor,  upon,  78. 
Electric  bath,  91. 
administration,  92. 
apparatus,  91. 
faradic,  92. 
galvanic,  92. 
in  morphinism,  92. 
sinusoidal,  92. 
technique,  91. 
therapeutics  of,  92. 
Embolism,  cerebral,  344,  345.  See  hem- 
orrhage, cerebral. 
Emissions,  seminal,  538. 
causes,  538. 
effects,  538. 
symptoms,  538. 
treatment,  538. 
Emphysema,  vesicular,  269. 
bath,  horizontal  rain,  269. 

incandescent  electric  light,  269. 
causes,  269. 
definition,   269. 
diet,  269. 
douche,  fan,  269. 

Scottish,  269. 
pack,  hot  blanket,  269. 
sheet,  dripping,  269. 
sponge,  cold,  269. 
treatment,  269. 
.  Endocarditis,  acute,  316. 
bag,  ice,  126,  316. 
bath,  Nauheim,  165. 
causes,  316. 
definition,  316. 
diet.  316. 
hygiene,   316. 
treatment,  316. 
chronic,  317. 
bag.  ice,  317. 
bath,  Nauheim,  317. 
causes,  317. 
pack,  full  dry,  317. 
sheet,  dripping,  317. 
sponge,  cold,  317. 
treatment,  317. 
Endometritis,  acute,  515. 
bath,  hot  sitz,  516. 
warm  full,  517. 


618 


INDEX. 


Endometritis,  causes,  515. 
convalescence,  517. 
compress,  trunk,  516. 
definition,  515. 
diet,  516. 
enema,  516. 
fomentation,  516. 
hygiene,   516. 
pack,  full  dry,  516. 
pelvic,  516. 
trunk,  516. 
pathology,  516. 
rub,  salt,  517. 
sheet,  dripping,  516. 
shower,  cold,  517. 
sponge,  cold,  516. 
symptoms,   516. 
treatment,  516. 
chronic,  517. 
affusion,  518. 
bath,  horizontal  rain,  518. 

incandescent   electric   light,   518. 
hot  sitz,  518. 
neutral  sitz,  518. 
warm   full,  518. 
causes,  518. 
definition,  518. 
diet,  518. 
douche,  jet,  518. 

vaginal,  518. 
fomentation,  518. 
hygiene,  518. 
pack,  pelvic,  518. 
rub,  salt,  518. 
shower,  cold,  518. 
sponge,  cold,  518. 
symptoms,  518. 
treatment,  518. 
Enema,  in  cellulitis,  pelvic,  acute,  528. 
in  cystitis,  548. 
in  dystentcry,  acute,  245. 
in  dysmenorrhea,  515. 
in  eclampsia,  522. 
in  endometritis,  acute,  516. 
in  enteritis,  acute.  243. 
in  hemorrhage,  586. 

cerebral,  346. 
in  hemorrhoids,  554. 
in  jaundice,  catarrhal,  284. 
in  migraine,  392. 
in  nephritis,  acute,  307. 
in  oophoritis,  acute,  525. 
in  prostatitis,  chronic,  537. 
in  rectum,  prolapse  of,  553. 
in  salpingitis,  acute,  524. 

chronic,  524. 
in  seasickness,  399. 
in  shock,  surgical,  585. 
in  uremia,    311. 
in  urine,    retention   of,   551. 
suppression  of,  547. 
Enema,  ice,  in  insolation,  413. 
Enteralgia,  250. 
Enteritis,  acute,  243. 
bag,  ice,  243,  244. 
bath,  cold  sitz,   145,  243. 

tepid   full,  244. 
compress,  hot,   131. 


Enteritis,  acute,  compress,  stimulating, 
128. 
cause,  243. 
definition,   243. 
diet,  243. 
enema,  243. 
fomentation,    122. 
hygiene,   243. 
pack,   full  wet,  243. 
sponge,  cold,  243. 
superheated   dry  hot  air,  84. 
symptoms,  243. 
treatment,  243. 
water  drinking,  243. 
chronic,   245. 
bag,  ice,  246. 
bath,  horizontal  rain,  246. 
hot  air,  246. 
hot   foot,  247. 

incandescent   electric   light,  246. 
cold  sitz,  246. 
Turkish,  246. 
cause,   246. 
definition,   246. 
diet,  246. 
hygiene,   246. 
sheet,  dripping,  246. 
symptoms,  246. 
treatment,  246. 
Enteroclysis,  94. 

Entero-colitis,     acute.       See     enteritis, 
acute. 
chronic.      See   enteritis,   chronic. 
Enteroptosis.      See    splanchnoptosis. 
Epididymitis,  534. 
bag,  ice,  534. 
bath,  hot  sitz,  534. 
causes,  534. 

compress,   stimulating,  534. 
definition,  534. 
fomentation,    534. 
symptoms,   534. 
treatment,  534. 
water   drinking,   534. 
Epilepsy,  374. 
affusion,  378. 

bath,  horizontal  rain,  379. 
hot   air,  378. 
half,  378. 

incandescent  electric   light,   378. 
warm   full,  378. 
causes,  375. 
definition,  374. 
diet,  376. 
douche,  jet,  379. 
hygiene,  376.  , 

management  of,  375. 
sponge,  cold,  378. 
superheated    dry    hot   air,   378. 
Epidaurus,   1. 

Equipment    of    hydrotherapetttic    insti- 
stutions,   107. 
of  sanatoria,   107. 
Erb,  Prof.,  10. 
Eroess,   154. 
Erysipelas,  220. 
bag,  ice,  220. 
bath,  full  cold,  220. 


INDEX. 


619 


Erysipelas,  cause,  220. 
compress,  cold,  220. 
definition,  220. 

fomentation,  220. 
hygiene,  220, 
medicine^    in,  220. 
nephritis,   treatment    of,   220. 
sponge,  cold,  220. 

treatment,    220. 

water  drinking,  220. 
Eskimo,   and   bath,   Russian,   74. 
Exercises    in    cardiac    disease,    organic, 
321. 

Fraenkel,  356. 

Oertel's    in    cardiac    disease,    organic, 
324. 
Exhaustion,   psychoses,   422. 
Exophthalmic  goitre,   381.     See  goitre. 

exophthalmic. 
Excretion,   physiological   action   hydro- 
therapy upon,  37. 

action  of  water  drinking  upon,  56. 
Exudates,  compress,  hot,  in,   130. 
stimulating,    128. 

superheated  dry  hot  air  128. 

water   drinking  in,  60. 

in  joints,  589. 
Eye,  diseases  of,  555. 

chronic,  579. 

treatment  of,  577. 
Eyeball,   diseases   of,   578. 

compress,  cold  in,  578. 

fomentation,  578. 

trauma  of,  578. 
Eyelids,  578. 

compress,   stimulating,   578. 

contusions  of,  578. 

fomentation,  578. 

Facial  spasm,  405.     See  spasm,  facial. 
Fan  douche.     See  douche,  fan. 
Farnese  bull,  4. 
faun,  4. 
Hercules,  4. 
"Father  Kneipp,"  cure,   142. 
Faun,  Farnese,  4. 
Feet,  cold,  574. 

bath,  cold   foot,  142,  574. 
causes,  574. 
douche,  Scottish,  574. 
fomentation,  574. 
pack,   trunk,   574. 
treatment,   574. 
sweating,  bath,  cold  foot,  in,  142. 
Felons,  bath,  local  hot,  142. 
"Fever  blister,"  -578. 
Fever,  delirium  of,  126. 

cold  and  cooling  compress,    126. 
dengue,  treatment,  213. 
hay,  263.     See  asthma,  bronchial. 
Montana,  spotted,  231. 
bath,  full  cold,  231. 
cause,  231. 
definition,  231. 
diet,  231. 
hygiene,   231. 
mortality,  231. 
pathology,  231. 


Fever.  Montana,  spotted,  symptoms,  231. 
treatment,   231. 
rheumatic,     288.       Sec     rheumatism, 

acute,    articular. 
scarlet,  215. 
affusion,  216. 
bath,  hot   full,  216. 

tepid  full,  216. 

warm    full,   216. 

sponge,   cold,   216. 
cardiac  failure,  217. 
cause,  215. 
convalescence,  21<S. 
convulsion,    217. 
definition,    215. 
diarrhea,  217. 
diet,  216. 
hygiene,   216. 
mortality,   215. 
nephritis,  217. 
pack,   full  dry,  217. 
pharyngitis,  217. 
symptoms,   215. 
tonsillitis,  217. 
treatment,  216. 
vomiting,  217. 
water  drinking,  216. 
simple,  196. 
bath,  cold  full,  198. 

hot  full,   198. 

sponge,  cold,  198. 
causes,  196. 
definition,    196. 
diet,  196. 
symptoms,   196. 
treatment,    197. 
malaria,  211. 

bath,  horizontal  rain,  213. 

hot  full,  212. 

incandescent   electric  light,  213. 

sponge,  cold,  212. 
cause,  211. 
definition,   211. 
diet,  211. 
douche,  jet,  213. 

Scottish,  213. 
hygiene,  212. 
pack,  full  dry,  212,  213. 

full  wet,  212. 
pathology,  211. 
prevention,  212. 
sheet,  dripping,  212. 
superheated  dry  hot  air,  213. 
symptoms,   211. 
treatment,  211. 
water   drinking,   212. 
surgical,  587. 
bag,  ice,  587. 
causes,  587. 
compress,  cooling,  587. 

stimulating,  587. 
definition,   587. 
fomentation,  587. 
pathology.  587. 

superheated  dry  hot  air,  587. 
treatment,  587. 
thermic,   410.     See   insolation, 
typhoid,   197. 


620 


INDEX. 


Fever,   typhoid,   action   bath,   full   cold, 
203,  205. 
of  friction,  203. 
bath,  cold  full,  200. 
and  friction,  200. 
in  neglected  cases,  207. 
and  whisky,  2U6. 
sponge,  cold,  in,  116,  199. 
tepid   full,    199. 
neutral,   199. 
cause,  197. 

of  fever,  202. 
circulation  in,  200. 
compress,  cold,  199,  126. 
definition,  197. 
diet,  197. 
hygiene,   198. 
mortality.  204. 
nervous   system   in,  201. 
pathology,   197. 
symptoms,   198. 
treatment,  204. 

of  cardiac  collapse,  208. 
of  constipation,   208. 
of  convalescence,    208. 
of  delirium,  207. 
of  diarrhea,  207. 
of  headache,  207. 
of  hemorrhage,  208. 
of  insomnia,   207. 
of  tympanites,  208. 
water  drinking,  60,   199. 
typhus,  230. 
bath,  cold  full.  231. 
cool  full,  230. 
neutral,  230. 
cause,  230. 
definition,  230. 
diet,   230. 
hygiene,  230. 
mortality  230. 
pack,   full  wet,  230. 
symptoms,  230. 
treatment,  230. 
yellow,  224. 

bath,  vapor,  225. 

sponge,   cold,  226. 
cause,  225. 
compress,  cold,  226. 
definition,  224. 
diet,  225. 
hygiene,  225. 
mortality,  225. 
pathology,   225. 
symptoms,  224. 
treatment,  225. 

of  cardiac  collapse,  226. 
of  delirium,   226. 
of  vomiting,  226. 
water   drinking,   225. 
Fevers,  194. 

bath,  half,  in,  149. 
sponge,  cold,  116. 
hot,  117. 
pack,  full  wet,  138. 
water  drinking  in,  60. 
Finns,  Russian  bath,  use  of,  75. 
Finsen,  Nils,  65. 


Flat  iron,  hot,  85. 
Floyer,  5,  6. 
Fleury,   Louis,  8. 
"Flesh   worms,"   565. 
Floor   plan    of    hydrotherapeutic   insti- 
tutions,   108. 
"Flux,  bloody."     See  dysentery,  acute. 
Folie  raisonnante,  425. 
Fomentation,  the,  121. 

apparatus,  121. 

contraindications,   123. 

in  acne,   123,  560. 

in  amenorrhea,   122,   511. 

in  anus,  fissure  of,  552. 

in  asthenopia.  578. 

in  asthma,  267. 

in  ataxia,   locomotor,  355. 

in  backache,   123. 

in  carbuncle,   565. 

in  cardiac  collapse,  334. 

in  cellulitis,  pelvic,  acute,  528. 
chronic,   528. 

in  cholelithiasis,  285. 

in  colic,   122. 

in  colic,   renal,  312. 

in  comedo,  566. 

in  congestion,  hepatic.  283. 
pulmonary,    260. 

in  contusions,  580. 

in  cystitis,  122,  548. 

in  dislocations,    123,   582. 

in  diphtheria,  218. 

in  dysmenorrhea,  122,  515. 

in  eczema,  557. 

in  endometritis,    chronic,    519. 

in  enteritis,  122. 

in  epididymitis,   534. 

in  erysipelas,  220. 

in  eyeball,  diseases  of.  578. 

in  eyelid,  contusions  of,  578. 

in  feet,  cold,   574. 

in  fever,   surgical,   587. 

in  fractures,  583. 

in  furuncle,   564. 

in  gastritis,    122. 
acute,  233. 

in  gastro-intestinal    neuroses,    251. 

in  gout,  295. 

in  headache,  123. 

in  "head  pressure,"   123. 

in  hemorrhoids,  554. 

in  herpes  zoster,  559. 

in  hepatitis,  122. 

in  hyperemia,  renal,  306. 

in  hypersecretion,  states  of.  239. 

in  jaundice,    catarrhal,    284. 

in  migraine,  392. 

in  muscular  spasm,   122. 

in  mumps,  219. 

in  myelitis,  acute,  349. 
chronic,  352. 

in  nephritis,  acute,  307. 

in  neuralgia,  341. 
ovarian,  122. 

in  neuritis,  acute,  336. 
multiple,  340. 
sciatic,  338. 

in  oophoritis,  acute,  525. 


INDEX. 


621 


Fomentation  in  orchitis,  535. 

in  pelvic  inflammation,  122. 

in  peritonitis,  122. 
acute,  280. 

in  pleuritis,  acute,  27X. 

in  pneumonia,  263. 

in  prostatitis,  acute,  536. 

in  pruritis  vulvae,  506. 

in  rectum,  prolapse  of,  553. 

in  rheumatism,      chronic      articular, 
292. 
muscular,  293. 

in   rhinitis,  acute.  254. 

in  seasickness,   400. 

in  shock,  surgical,  585. 

in  spasm,   facial,  406. 

in  spinal  irritation,   123. 

in  sphincter   ani    divulsion,    123. 

in  sprains,  123,  581. 

in  suppressed  menstruation,   122. 

in  surgery,  abdominal,  588. 

in  surgical  cases,  123. 

in  ulcer,  gastric,  240. 

in  uremia,  311. 

in  urine,  suppression  of,  547. 

in  vidval  inflammations,  122. 

physiological  action  of,  122. 

technique,  121. 

temperature  of,  122. 

therapeutics  of,  122. 
Foot  bath.     See  baths,  foot. 

cold.     See  baths,  cold  foot. 
Foot  baths,  hot.     See  baths,  hot  foot. 
Fractures,  583. 

bath,  continuous,  583. 

causes,  583. 

definition,  583. 

fomentation,  583. 

treatment,  583. 
Fraenkel,  H.  S.,  352.  355,  356. 
Friction,  88. 

bath,  cold  full  in,  168,  170. 

flesh  brush  with,  88. 
mitten,  88. 

with  hand,  88. 

in  insolation,  412. 

in  tuberculosis,  273. 

physiological  action,  88. 

technique,  88. 

therapeutics,  88. 
Full  bath.     See  bath,   full. 

cold.     See  bath,  cold  full. 

hot.     See  bath,  hot  full. 

very  hot.     See  bath,  very  hot  full. 
Full  dry  pack.     See  pack,   full  dry. 
Functional     nervous     diseases,     Chap- 
man's ice  bags  in,  87. 

sponge,  hot,  in,   117. 
Furuncle,  563. 

causes,  563. 

definition,  563. 

fomentation,  563. 

pathology,  563. 

Galen,  5. 

Gall-stones,   water  drinking  in,  60. 
Gangrene,  593. 
causes,  593. 


'  rangrene,  definition,  593. 
sponge,  cold,  593. 
superheated  dry  hoi  air,  593. 
treatment,  593. 
Gastralgia,  249. 

water  drinking  in,  61. 
Gastric  atony.     See  atony,  gastric. 
hyperesthesia,  250. 
dilatation.      See   dilatation,    gastric, 
neuroses,  249. 

treatment  of,  251. 
pains,  bag,  ice,  in,  126. 
ulcer.     See  ulcer,  gastric. 
Gastritis,  acute,  233. 
bag,  ice,  233. 
bath,  hot  foot,  233. 
compress,   hot,    131. 

abdominal,  233. 
cause,  233. 
definition,   233. 
diet,  233. 

fomentation,  122,  233. 
compress,  stimulating,  128. 
hygiene,  233. 
pack,  hot  half,  233. 
treatment,  233. 
water  drinking,  233. 
chronic,  233. 
bags,  Chapman's  ice,  235. 
bath,   horizontal    rain,   234. 
hot  air,  234. 

incandescent  electric  light.  234. 
causes,  234. 
definition,  233. 
diet,  234. 
douche,  jet,  234. 

Scottish  fan,  234. 
girdle,  Neptune's,  -235. 
hygiene,   234. 
lavage,  234. 
sheet,   dripping,   234. 
symptoms,  234. 
treatment,  234. 
water   drinking,  234. 
chronic  sthenic.     See  hypersecretion, 
states   of. 
Gastro-entero-colitis,    acute.      See    en- 
teritis,  acute, 
intestinal  neuroses,  251. 
bag,  ice,  251. 

bath,  horizontal  rain,  251. 
hot  air,  251. 

incandescent  electric  light,   251. 
compress,  abdominal,  251. 
douche,  fan,  251. 

jet,  251. 
fomentation,  251. 
lavage,  251. 
pack,  full  dry,  251. 
sheet,  dripping,  251. 
surf  bathing,  251. 
water  drinking,  251. 
ptosis.     See  splanchnoptosis, 
spasm,  250. 

succorrhea.         See       hypersecretion, 
states  of. 
General  treatment  room  in  hydrother- 
apeutic  institution,   109. 


622 


INDEX. 


Genitourinary  diseases,  533. 

Gibbon's  history  of  the  Roman  people, 

4. 
Girdle,  Neptune's,  133. 

in  gastritis,  chronic,  235. 
Glands,  sebaceous,  17. 

sweat,  16. 
Glenard's    disease.      Sec  splanchnopto- 
sis. 
Gluck,  459.' 
Goethe,  64. 

Goitre,  exophthalmic,  380. 
bag,  ice,  126,  382. 
bath,  horizontal  rain,  382. 

incandescent  electric  light,  382. 
Nauheim,  382. 
causes,  381. 
definition,  380. 
diet,  382. 
douche,  jet,  382. 
hygiene,  382. 
operation  in,  382. 
sheet,  dripping,  382. 
symptoms,  381. 
treatment,  383. 
Goldscheider,  221,  356. 
Gonorrhea,  533. 
bag,  ice,  534. 
bath,  hot  sitz,  533. 
cause,  533. 
compress,  cold,  534. 
definition,  533. 
douche,  vaginal,  534. 
diet,  533. 
hygiene,  533. 
pathology,  533. 
sequelae,  533. 
treatment,  533. 
Gout,  280.  295. 

bath,  horizontal  rain,  296. 
hot  air,  296. 
hot  full,  296. 
incandescent    electric    light,    73, 

295. 
Xauheim,  165. 
Russian,  296. 
Turkish,  296. 
causes,  295. 

convalescence,    treatment    of,    297. 
compress,  cold,  295. 

stimulating,  296. 
definition,  295. 
diet,  295. 

douche,  Scottish,  296. 
fomentation,  295. 
hygiene,  295. 
prevention  of,  29S. 
retrocedent  forms,  298. 
superheated  dry  hot  air,  84,  295. 
sunlight  in,  67. 
treatment,   295. 
water  drinking,  60. 
"American,"  295. 
Gowers,   Sir  William,  360. 
Groedel,  330. 
Gray,  L.  C.,  426,  432. 
Greeks,  1. 
Grippe,  la,  208. 


ie,  bath,  horizontal   rain,  in.  210. 
hot  full,  210. 

incandescent  electric  light,  210. 
causes,  208. 
definition,  208. 
diet,  210. 
douche,  fan,  211. 
jet,  211. 

Scottish,   fan,  211. 
hygiene,  209. 
pack,   full  dry  hot,  210. 
pack,  full  wet,  210. 
pathology,  208. 
sponge,  cold,  210. 
superheated  dry  hot  air,  210. 
symptoms,  209. 
treatment,  210. 

of  convalescents,  210. 
Guinon,  223. 

Gymnasium,  open  air,  66. 
Gymnastics,  Schott's,  321. 

Habit,  cannabis  indica,  435. 
chloral.  435. 
cocaine,  435. 
coffee,  453. 

bath,  horizontal  rain,  454. 

incandescent   electric   light,  454. 
sponge,  cold.  454. 
douche,  jet,  454. 

physiological  action,  453. 
symptoms  of,  453. 
treatment,   454. 
uses  of  in,  454. 
water  drinking,  454. 
drug.  435. 
morphine,  435. 
patent  medicine,  474. 
spasm,  405.     See   spasm,  habit, 
tea,  455. 

action  upon  circulation,  455. 
heart,  455. 
nervous  system,  455. 
physiological,  456. 
symptoms,  455. 
treatment,  456. 
tobacco,  445. 

action  upon  circulation,  449. 
eyes,  450. 
heart,  449. 
intestines,   448. 
nervous  system,  450. 
mouth,  448. 
respiration,   448. 
bath,  horizontal  rain,  452. 
hot  full,  452. 

incandescent  electric  light,  452. 
shower,  452. 
sponge,  cold,  452. 
chemical  constituents,  446. 
digestive    disturbances,    treatment, 

455. 
douche,  jet,  452. 
effects  of,  448. 
excess,  446. 

insomnia,  treatment  of,  455. 
nervousness,  treatment  of,  455. 
physiological  action  of,  447. 


INDEX. 


62- 


Habit,  tobacco,  prognosis  of,  451. 

treatment  of,  451. 
use,  methods  of,  446. 
water  drinking,  45.3. 
Haig,  Alexander,  102,  455. 
Half  bath,   147.     See  bath,  half. 
hot.   149.     See  bath,   half   hot. 
pack,  dry,   141.     Sec  pack,  half  dry. 
wet,  139.     See  pack,  half  wet. 
Hallmann,  7,  8. 

Harry    T.,    576. 
Hands,   cold,   574. 
causes,   574. 
treatment,  574. 
flair's  walks  in  Rome,  5. 
Hare,  II.  A.,  202. 
Harnack,  460. 
Hart.   Ernest,  227. 
Hasheesh,  435. 
Hawk,  57. 

Hawthorne,  Nathaniel,  Marble  Faun, 4. 
Hay  asthma,  268.     See  asthma,   bron- 
chial, 
fever,  268.     See  asthma,  bronchial, 
ice  bag,  Chapman's  in,  87. 
Headaches,  386. 
anemic,  treatment  of,  387. 
arterio-sclerotic,  384. 

bags,  ice,  Chapman's,  87. 
bath,  horizontal  rain,  386. 
hot  air,  386. 

incandescent  electric  light.  386. 
sponge,    alternate    hot   and    cold, 
118. 
cold,  386. 
causes,  384. 
compress,  cold  and  cooling,  126. 

hot,  130. 
definition,  384. 
diagnosis,  386. 
douche,  fan,  386. 

jet,  386. 
fomentation,    123. 
functional,   386. 
hyperemic,  treatment  of,  387. 
in     insanity,    confusional,    treatment 
of,  424. 
hygiene,  387. 
meningeal,  384. 
nervous,  391.     See  migraine, 
neuropathic,  treatment  of,  388. 
organic,  treatment  of,  388. 

pain,  causes  of,  386. 
reflex,  treatment  of,  388. 
sick,   391.      See  migraine. 

sheet,   dripping,  386. 
toxic,  treatment  of,  387. 
traumatic,  384. 
treatment,  387. 
in   typhoid,   207. 
Head    compress.      See    cephalic    com- 
press, 
"fullness,"   142. 

baths,  hot  foot,  in,  142. 
"pressure,"  123. 

fomentation   in,   123. 
Heart,  "cold  water,"  319. 
disease,   functional,  332. 


i  lean,  diseases  of,  316. 
bag,  ice,  335. 

bath,  horizontal  rain,  334. 
incandescent  electric  light,  334. 
sponge,  cold,  334. 
diet,  334. 
douche,   fan,  335. 

jet,  335. 
hygiene,  334. 
pack,   full   dry,  334. 
sheet,  dripping,  334. 
treatment,  334. 
failure,  bag,  ice,  in,  126. 
disease,  organic,  326. 
hydrotherapy  in,  104. 
treatment  of,  317. 
weak,  332. 

failure,   treatment    of,   during   opera- 
tion,  589. 
fatty,  328. 
bath,   Nauheim,  328. 
causes,  328. 
treatment,   328. 
Heat,  by  conduction,  75. 
physiological  action,  75. 
stroke,  410.     See  insolation. 
Hebra,   160,  223. 
!  lebrews,   1. 
Hector,   1. 
Hedley,  93. 
Heihnere,  58. 

Hemicrania,  391.     See  migraine. 
"Hemiplegia."   treatment   of,   347. 
Hemoptysis,  261. 
Hemorrhage,    :" 
causes,  586. 
compress,  cold,  586. 
and  ice  cap,  586. 
definition,  586. 
enema,  586. 
symptoms,  586. 
varieties,  586. 
treatment,  586. 

in  typhoid.  208. 
water   drinking,   587. 
cerebral.  344. 
bag,  ice,  346. 
bath,  half.  347. 

horizontal  rain,  347. 
incandescent   electric   light,  347. 
warm  full,  347. 
causes,  344. 
compress,  cephalic,  346. 

trunk,  346. 
definition,   344. 
diet,  345. 
enema,   346. 
hygiene,  345. 
pack,  half,  347. 
prevention  of,  345. 
treatment,  346. 
water  drinking,  346. 
gastric,  ice  bag,  in,  126. 
intestinal,  ice  bag,  in,  126. 
pulmonary,  261. 
bag,  ice,  261. 

Chapman's  hot  water,  261. 
causes,  261. 


624 


INDEX. 


Hemorrhage,  pulmonary,  definition  of, 
261. 

diet,  261. 
hygiene,  261. 
treatment,  261. 
uterine,  520. 

bag,  Chapman's  ice,  520. 
bath,  cold  sitz,  520. 
horizontal   rain,   520. 
hot  foot,  520. 

incandescent  electric  light,  520. 
causes,  520. 
compress,  trunk,  521. 
definition,  520. 
diet,  520. 

douche,  vaginal,  520. 
pack,  pelvic,  521. 
half  wet,  521. 
sheet,  dripping,  520. 
Hemorrhoids,  553. 
bag,  ice,  554. 
bath,  hot  foot,  554. 
horizontal  rain,  554. 
incandescent  electric  light,  554. 
cold  sitz,  554. 
hot  sitz,  147,  554. 
causes,  553. 
compress,  cold  and  cooling,   126. 

hot,  131. 
definition,  553. 
douche,  perineal,  554. 
enema,  554. 
fomentation,  554. 
symptoms,  554. 
treatment,  554. 
Hepatic   cirrhosis,   286.      See   cirrhosis, 
hepatic, 
congestion,  283.     See  congestion,  he- 
patic, 
diseases,  water  drinking  in,  60. 
Hepatitis,     compress,     stimulating,     in, 
128. 
fomentation  in,  128. 
Hercules,  Farnese,  4. 
Herpes,  simplex,  558. 

bath,  horizontal  rain,  558. 
hot  air,  558. 

incandescent  electric  light,  558. 
causes,  558. 
definition,  558. 
douche,  fan,  559. 

jet,  559. 
superheated  dry  hot  air,  558. 
treatment,  558. 
zoster,  559. 
causes,  559. 
compress,  hot,  559. 

neutral,  559. 
definition,   559. 
fomentation,  559. 
pathology,   559. 
treatment,  559. 
Hindoos,  1. 

Hip  bath.     See  bath,  sitz. 
Hippocrates,  2,  54. 
Hirschberg,  356. 
History  of  hydrotherapy.    1. 
Hives,  55. 


Hodge.  362. 

Hodgkin's  disease,  314. 

Hoesslin,  V.,  303. 

Hoffmann,  Frederick,  6,  13,  319. 

Holmes,  Oliver  Wendell,  499. 

Homer,   1. 

"Hose."     See  douche,  jet. 

Hot  air,  77. 

action  upon  blood,  77. 
circulation,  76. 
digestion,  77. 
elimination,  78. 
metabolism,  77. 
muscular  fibre,  77. 
nervous  system,  77. 
respiration,  77. 
temperature,  78. 
cabinet,  74. 
apparatus,  79. 
construction,  79. 
physiological  action,  74. 
technique,  80. 

superheated     dry,     74.       See     super- 
heated dry  hot  air. 
sponging,  117. 

in     nervous     diseases,     functional, 
117. 
and  cold  sponge,  alternate,  118. 
apparatus,    118. 
to  spine,  118. 
technique,  118. 
water  coil,  85. 
in  gastritis,  58. 

physiological     action     internally, 
58. 
bag.  85. 

Chapman's,   86. 

action   upon  circulation,  87. 

nervous  system,  87. 
physiological  action,  87. 
bottle,  85. 
jug,  85. 
Houchard,  H.,  330,  449. 
Huebner,  258. 
Hufland,  8. 
Hunner,  Guy  L.,  548. 
Hutchinson,  Jonathan,   590. 
Hydel,  L,  93. 

Hydrotherapeutic      institutions,       con- 
struction of,  109. 
cooling  room  in,  109. 
douche  room  in,  109. 
dressing  rooms  in,   108. 
equipment  of,  107. 
floor  plan,  108. 
general  treatment  room,   109. 
hot  water  supply,  108. 
rest  room,  108. 
toilet,  109. 

mineral  waters,  use  of  in,  108. 
slat  floor,  110. 

temperature  of  bath  rooms,   108. 
water  supply  for,  107. 
methods,  minor,  85. 
sanatoria.     See  institutions. 
Hydrotherapeutics,   clinical   order,    115. 
duration  of  treatment,  96. 
elements  of  stimulation,  114. 


INDEX. 


625 


Hvdrotherapeutics,     examination     for, 

95.  ' 

habit,  99.  ' 

hours   for,  99. 
nurse,  95. 
reaction,  49. 
recovery  under,  102. 
regulations,  95. 

rules,  95. 

stimulation,    114. 

suggestions,  95. 

training  of  patient,  98. 
Uygeia,    1.  .  . 

Hydrotherapy,   action    in   neurasthenia, 

action   upon   chronic   invalids,    101. 

and  age,  100. 

and  the  sedentary,  102. 

as  a  therapeutic  weapon,  114. 

benefits  to  women  of,  103. 

"catching  colds"  from,  101. 

contraindications  of,  53. 

history  of,  1. 

in  anemia,  104. 

in  inflammations,  acute,  1U4. 

chronic,  104. 
in  health,  101.  .         -A 

in  heart  disease,  organic,   104. 
in  skin  diseases,  chronic,  105. 
technique,  114,  150. 

classification  of,  114. 
to  prevent  disease,  101. 
Hyperesthesia,  in  neuroses,  sexual,  i»43. 

vulvo-vaginal,  506. 
Hyman,  153. 

and  Klebs,  157. 
Hyperchvlia.  See        hypersecretion, 

states  of. 
Hyperchlorhydria.        See      hypersecre- 
tion, states  of. 
Hyperemia,  cerebral,  410. 
renal,  306. 
bag,  ice,  j07. 
bath,  cold  sitz,  307. 

Turkish,  307. 
causes,  306. 

convalescence,   treatment   ot,   W/ . 
definitions,  306. 
diet,  306. 
fomentation,   307. 
hygiene,  306. 
pack,  full  dry,  307. 
superheated  dry  hot  air,  307. 
treatment,  306. 
water  drinking,  307. 
Hyperidrosis,  568. 
bath,  cold  foot,  569. 
horizontal  rain,  568. 
incandescent  electric  light,  368. 
causes,  568. 
definition,  568. 
douche,  fan,  568. 

jet,  Scottish,  569. 
symptoms,  568. 
treatment,  568. 
Hyperkoria,  250.  ,  •  ,  ■ 

Hyperpepsia,    hot    water    drinking    m, 
61. 


lyperperistalsis,  250. 
[ypertrophy,  cardiac,  ■'-*■ 
[ypersccretion,  states  of,  ^38. 
hath,  hoi   air,  239. 
horizontal  rain,  239. 
incandescenl  electric  light,  IM. 
hoi  full,  239. 
cold  sitz,  239. 
sponge,  cold,  239. 
cause,  238. 
definition,  238. 
diet,  238. 
douche,  jet,  239. 

fan,  239. 
fomentation,  239. 
hygiene,  238. 
rub,  salt,  239. 
sheet,  dripping,  239. 
symptoms,  238. 
treatment,  239. 
water  drinking,  238. 
Hypochlohydria.      See     hyposecretion, 

states  of. 
Hypochylia.     See  hyposecretion,  states 

Hypopepsia.     See  hyposecretion,  states 

of. 
Hypopyon,  578. 
Hyposecretion,  states  ot,  0*1. 
bag,  ice,  242. 
bath,  hot  air,  242. 
horizontal  rain,  242. 
incandescent  electric  light.   _4_. 
causes,  241. 
definition,  241. 
diet,  241. 
douche,   fan,  242. 

jet,  242. 
hygiene,  241. 
lavage,  242. 
rub,  salt,  242. 
surf  bathing,  243. 
swimming,  243. 
symptoms,  241. 
treatment,  241. 
water  drinking,  242. 
Hysteria,  368. 
affusion,  372. 

anesthesia,  treatment  of ,  .5/4. 
anorexia,  treatment  of,  3/4. 
aphonia,  treatment  of,  373. 
bath,  hot  air,  372. 
horizontal  rain,  372. 
incandescent  electric  light,  74,  Si - 
neutral,  158. 
causes,  369. 

contractures,  treatment,  3/4. 
convulsions,  treatment.  3/4. 
definition,  368. 
douche,  fan,  372. 
jet,  372. 
Scottish,  372. 
douches  in,  192. 

hydrotherapy  of  rest  cure,  6/1. 
hyperesthesia,  treatment,  374. 
pack,  full  dry,  372. 

full  wet,  373. 
pain,  treatment,  374. 


626 


JXDEX. 


Hysteria,   paresthesia,   treatment,   374. 
paralysis,  374. 
prophylaxis  of,  373. 
sheet,  dripping,  372. 
symptoms,  368. 
superheated  dry  hot  air,  84. 
surf  bathing,  373. 
swimming,  373. 
treatment,  370. 
vomiting,    treatment,   374. 

Ice  bag  and  distal  circulation,  127. 
in  appendicitis,   126. 
in  cardiac  disease,   126. 
in  endocarditis,   126. 
in  gastric  pains,  126. 
in  heart  failure,   126. 
in  hemorrhage,  gastric,   126. 

intestinal,  126. 
in  myocarditis,   126. 
in  pneumonia,   126. 
in  vomiting,  126. 
to  increase  appetite,  126. 
technique,  127. 
with  compress,   125. 
bags,  Chapman's,  86. 
action  upon  circulation,  87. 

nervous  system,  86. 
in  asthma,  87. 
in  bronchorrhea,  87. 
in  constipation,  87. 
in  hay  fever,  87. 
in  headache,  87. 
in  indigestion,  87. 
in  insomnia,  87. 
in  leucorrhea,  87. 
in  migraine,  87. 
in  neuralgia,  87. 

in  nervous   disease,   functional,  87. 
in  neurasthenia,  87. 
in  vomiting,   87. 
physiological  action,  87. 
helmet,  73. 

during    incandescent    electric   light 
bath,  73. 
Icterus.     See  jaundice,  catarrhal,  284. 
Impotence,  540. 

bath,  horizontal   rain,  541. 

incandescent   electric  light,   541. 
cold  sitz,  541. 
causes,  540. 
definition,  540. 
douche,  jet,  541. 
perineal,   541. 
treatment,  541. 
paralytic,  541. 
Impotentia  cceundi,  540. 
Incandescent   electric   light   bath.      See 
bath,       incandescent       electric 
light. 
Indigestion,  Chapman's  ice  bags  in,  87. 
of  menopause,  treatment  of,  532. 
rub,  salt,  90. 
sheet,  dripping,  120. 
Inebriety,  457,  496. 
causes,  496. 
definition,  496. 
prodromes,  496. 


Inebriety,  treatment,  497. 
Infant,  bathing  of,   155,  503. 

bath  in  summer,  156. 
Infectious  diseases,  194. 
Infections,  local,  84. 

superheated  dry  hot  air,  local,  84. 
Infection,   septic,  593. 
bag,  ice,  593. 
causes,  593. 
compress,  cooling,  593. 
definition,  593. 
diet,  593. 
hygiene,  593. 
pathology,   593. 
sponge,  cold,  594. 
symptoms,  593. 
superheated  dry  hot  air,  593. 
Inflammations,  baths,  hot  foot  in,   141. 

compress,  cold  and  cooling,  125. 
acute,-  hydrotherapy  in,   104. 
chronic,  hydrotherapy  in,   104. 
respiratory,  prevention  of,  277. 
Influenza.     See  grippe. 
Insanity,  alcoholic,  422. 
chronic  delusional,  425. 
of  cocaine,  422. 
confusional,  422. 

bath,  horizontal  rain,  425. 

incandescent    electric    light,    425. 
sponge,  cold,  424. 

causes,  422. 

convalescence,  425. 

definition,  422. 

diet,  423. 

douche,  fan,  425. 
jet,  425. 

pack,  full  wet,  424. 

rub,  oil,  424. 

sheet,  dripping,  425. 

symptoms,  422. 

treatment,  423. 
drug,  422. 

manic  depressive,  415. 
of  morphinism,  422. 
post-febrile,  422. 
post-operative,  422. 
Insolation,  412. 
affusion,  412. 
bath,  cold  full,  413. 

horizontal  rain,  414. 

incandescent  electric  light,  414. 

sponge,  cold,  413. 
causes,  410. 
compress,  cold,  412. 
convalescence,  414. 
definition,  410. 
douche,  jet,  414. 
enema,  ice,  413. 
friction,  412. 
hygiene,  412. 
pack,  full  wet,  413. 
pathology,  411. 
symptoms,  411. 
treatment,  411. 
Insomnia,  392. 
bag,  ice,  396. 

Chapman's,  87,  396. 
bath,  hot  foot,  142,  396. 


INDEX. 


<,J7 


Insomnia,    bath,    horizontal     rain,    in, 
395. 
incandescent  electric  light,  74,  395. 

neutral,    157,  395. 
cold  sit/,  396. 
causes,  393. 
definition,  393. 
diet,  394. 
douche,   fan,  395. 

jet.  395. 
hygiene,  394. 
Neptune's  girdle,  396. 
pack,  full  wet,  138,  395. 
sheet,  dripping,  120. 
sponge,    alternate    hoi     and    cold    to 

spine  118,  396. 
treatment,  394. 

in  alcoholism,  chronic,  493. 
in  insanity,   con f visional,   424.. 
of  menopause,  532. 
in  tvphoid,  207. 
Intercostal    neuralgia,    340.      See    neu- 
ralgia. 
Intermittent    fever.      Sec    fevers,    ma- 
larial. 
Internal  uses  of  water,  54. 
Intestinal  atonv.     See  atony,  intestinal, 
neuroses,  249. 

treatment  of,  251. 
Intestines,  diseases  of,  233. 
Iritis,  578. 

Jacobi,  137. 
Janeway,  T.  C,  463. 
Japanese,  6,   150. 

and  bath,  hot  full.  151,  152. 
Jaundice,  catarrhal,  284. 
bath,  hot  air,  284. 
horizontal  rain,  284. 
incandescent  electric  light,  284. 
cold  sitz,  284. 
causes,  284. 

compress,  stimulating,  284. 
definition,  284. 
diet,  284. 
douche,  fan,  285. 

jet,  285. 
enema,  284. 
fomentation.  2S4. 
hygiene,  284. 

pruritus,  treatment  of,  284. 
sheet,  dripping,  284. 
treatment,  284. 
water  drinking,  284. 
Jet  douche.     See  douche,  jet. 
Joint   compress.      See   compress,   joint, 
134._ 
diseases,  589. 

bath,     sponge,     alternate    hot    and 
cold  in,  126. 

superheated    dry    hot    air,    local, 
84. 
compress,  cold  and  cooling  in,  126. 
Joints,   adhesions   of,   589. 
contractures  of.  589. 
exudates  in,  589. 
Juettner,  Otto,  64. 
Jug,  hot  water,  85. 


Kaposi,  593. 

Kellogg,  I.  II..  19,  23,  28,  36,  46,49,  52, 
65,  6&  7(i,  91,  124,  129,  137, 
161,  202,  206,  216,  238,  245, 
264,  461,  465.  524,  529,  559,  562, 
567,  573,  574,  577. 
Keratitis,  interstitial,  57X. 

phlyctenular,  57s. 
Kerr,  Norman,  459,  460,  472,  476,  485. 
Kidney,  diseases  of,  306. 

hydrotherapeutic  rules  in,  96. 
superheated  dry  hoi  air  in,  84. 
floating,  311.     Sec   splanchnoptos 
Klebs,  153. 

Knopf,  S.  A.,  273,  274. 
Korsakoff's  psychos,-,  422. 
Kraepelin,  Emil,  450. 
Kraft-Ebing,  R.  von,  431,  538. 

La  grippe.     See  grippe,  la. 

Landry's  paralysis,  347.     See  myelitis, 

acute. 
Laryngismus  stridulus,  256.  See  laryn- 
gitis, spasmodic. 
Laryngitis,    acute,    254.      See    rhinitis, 
acute, 
chronic,  254.     See   rhinitis,  chronic, 
croupous,  256. 
cause,  256. 
compress,  cold,  2o6. 
definition,  256. 
mortality,  256. 
treatment,  256. 
spasmodic,  256. 
bath,  hot  full,  256. 
compress,  throat,  256. 
definition,  256. 
hygiene,  256. 
steam  inhalations.  256. 
Larynx,  diseases  of,  253. 
Lavage,  94. 

in  alcoholic   intoxication,   acute,   4/8. 
in  atony,  gastric,  235. 

intestinal,  235. 
in  dilatation,  gastric,  235. 
in  gastritis,  234. 

in  gastro-intestinal  neuroses.  251. 
in  hyposecretion,  states  of,  242. 
in  migraine,  391. 
in  vertigo,  397. 
Lee,  Elmer,  228. 
Lees,  264. 
Leiter  coil,  123. 

with   compress.    125. 
Leloir,  574. 
Leprosy,  574. 
bath,  hot  full,  575. 
medicated  full,  576. 
warm    full,   576. 
definition,  574. 
pathology,  575. 
treatment,   575. 
varieties,  574. 
Leptomeningitis,  acute,  342.    .See  men- 

•"'itiS-  .        •  ,  07 

Leucorrhea.  Chapman  s  ice  bags  in,  »/. 
Leukebad,  160. 

bath,  continuous,  at,   160. 


628 


INDEX. 


Leucocythemia,  314. 
Leyden,  356. 

Liebermeister,  137,  138,  202. 
Liebig,  Baron,  105. 
"Life,  change  of,"  530. 
Light  rays,  62. 
of  sun,  62. 
waves,  62. 

bath,   incandescent  electric,   67.      See 
bath,       incandescent       electric 
light. 
Lithemia,  298. 
bath,  hot  air,  299. 
horizontal  rain,  299. 
hot  full,  299. 
incandescent      electric      light.      73, 

299. 
Russian,  299. 
Turkish,  299. 
causes,  298. 
definition,  298. 
diet,  298. 
douche,  jet,  299. 
pack,  full  wet.  298. 
treatment,   298. 
Lithemic  gout,  295. 
Liver,  diseases  of,  280. 
Local  baths,  141. 

baths,  cold,  in  nose  bleed,   142. 
cold,  85. 

physiological  action,  85. 
heat,  85. 

physiological  action,  85. 
dry  hot  air,  superheated,  78. 
incandescent      electric      light      bath, 
70. 
physiological  action,  70. 
Locomotor   ataxia.      See   ataxia,    loco- 
motor, 352. 
bath,  continuous,  159,  160. 
half,  148, 
'Nauheim,  165. 
superheated  dry  hot  air,  84. 
Loomis,  H.  P.,  202,  265,  271. 
Lorsch,  245. 
Lues,  543. 
Lumbago,  293. 

bath,   incandescent   electric   light,   lo- 
cal, 74. 

Maggiori.  138. 
Magi  of  Persians,  1. 
Malaria,  cachexia,  213. 
treatment,  213. 
chronic,    bath,    incandescent    electric 
light  in,  74. 
poisoning,  213. 
Mai  de  mer,  399.     See  seasickness. 
Mania,  415. 

bath,  horizontal  rain,  417. 

incandescent  electric  light,  417. 
neutral,  417. 
sponge,  cold,  417. 
causes,  416. 
convalescence,  417. 
definition,  415. 
diet,  417. 


Mania,  treatment,  -417. 
pack,  full  wet,  417. 
prognosis,  416. 
symptoms,  416. 
acute  alcoholic,  457,  487. 
bath,  sponge,  cold,  488. 
definition,  487. 
pack,  full  wet,  488. 
symptoms,  488. 
treatment,  488. 
pathology,  488. 
prognosis,  488. 
a  potu,  457,  487. 
Manic-depressive  insanity,  457. 
Marchiafava  and  Bignani,  212. 
Malarial  fevers.     See  fevers,  malarial 
Massey,  G.  Betton,  512. 
Masturbation,  538. 
Mays,  Thomas  J.,  126,  264. 
Meals,  baths  after,  97. 
Measles,  214. 
affusion,  214. 
bath,  hot  full,  214. 
warm  full,  214. 
sponge,  cold,  214. 
causes,  214. 

complications,  treatment  of,  214. 
compress,  abdominal,  214. 
chest,  214. 
throat,  214. 
definition,  214. 
pack,  half,  214. 
pathology,  214. 
treaUuent,  214. 
water  drinking.  214. 
German,  214. 
Mechanical  effects  of  water,   12. 
Melancholia,  417. 
bag,  ice,  421. 
bath,  hot  air,  421. 
horizontal  rain,  421. 
incandescent  electric  light,  421. 
neutral,  420. 

sponge,  hot  and  cold  spinal,  421. 
causes.  419. 
definition,  418. 
diet,  420. 
douche,  jet,  421. 
douches  in,   192. 
hygiene,  420. 
pack,  full  wet,  420. 
prognosis,  419. 
rub,  oil,  420. 
sheet,  dripping,  420. 
symptoms,  421. 
treatment,  419. 
Meningitis,   342. 
bag,  ice,  344. 

Chapman's  spinal  ice,  344. 
bath,  hot  full,  344. 

sponge,  cold,  344. 
cap,  cerebral  coil  in,  85. 
causes,  343. 

compress,  cold  and  cooling,   126. 
definition,  343. 
diet,  343. 
hygiene,  343. 


INDEX. 


629 


Meningitis,  treatment,  343. 
cerebrospinal,  epidemic,  222. 
bag,  Chapman's  ice,  221. 
bath,  hoi  full,  153,  221. 

warm  full,  154. 
cardiac  collapse,  treatment,  222. 
cause,   221. 

convalescence,  treatment,  222. 
definition,  221. 
hygiene,  221. 
mortality,  221. 
pathology,   221. 
symptoms,  221. 
treatment,  221. 
spinal.  342.      See  meningitis. 

chronic,  148. 
tubercular,   342.      See   meningitis. 
Menopause,   530. 
bath,  horizontal   rain,  532. 
hot  full,  532. 

incandescent  electric  light,  532. 
sponge,  cold,  531. 
Turkish.  532. 
causes,  532. 

changes  in  sexual  organs,  531. 
definition,  530. 
diet,  531. 
douche,  jet,  532. 
hygiene,  531. 
shower,  cold,  532. 
sheet,  dripping,  532. 
symptoms,  531. 
treatment,  531. 
Menorrhagia,    520.      See    hemorrhage, 

uterine. 
Menstruation,  baths  during,  96. 
sunpressed,  bath,  hot  sitz,  in,  146. 
fomentation  in,   122. 
Mental  diseases.  415. 

excitement    in    insanity,    confusional, 
treatment,  424. 
Mercurialism,  treatment  of,  546. 
Mercury,    superheated    dry   hot   air   as 

eliminant,  84. 
Merycism,  250. 

Metabolism,   action   of  bath,   cold   full, 
upon,  173. 
hot  full,  upon,  151. 
cold  sitz,  upon,  144. 
hot  sitz,  upon,  146. 
hot  air,  upon,  77. 
Xauheim,  upon,   164. 
Russian,   upon,   77. 
Turkish,  upon,  77. 
vapor,  upon, 77. 
incandescent      electric      light      upon, 

69. 
superheated  dry  hot  air,  upon,  77. 
douche,  cold  upon,   191. 

hot,  upon,   188. 
pack,  full  wet.  upon,  137. 
water  drinking  upon,  57. 
Metallic     poisoning,     superheated     dry 

hot  air  in,  84. 
Metchnikoff,  Elie,  48. 
Meteorism,  250. 

Metritis,  acute,  515.     See  endometritis, 
acute. 


chronic.      517.       See      endometritis, 
chronic. 
Metrorrhagia,    520.  hemorrhage, 

uterine. 
Migraine.  388. 
affusion,  391. 
bag,  ice,  389. 

(  hapman's,  .'-'7. 
bath,  half,  391. 
hot  foot,  389. 
horizontal   rain,  391. 
warm   full,  391. 

incandescenl   electric   light,  74,391. 
neutral,  391. 
causes,  389. 
compress,  hot,   130. 
definition,  3SS. 
diet,  389. 
douche,  jet,  391. 
enema,  389. 
fomentation.   389. 
hygiene,   389. 
lavaee,    389. 
pack,  full  dry,  390. 

full  wet,  391. 
rub,  salt,  391. 
sheet,  dripping,  390. 
treatment,  389. 
water  drinking,  389. 
Miliaria,  570. 

bath,  neutral,  571. 

sponge,  cold,   571. 
causes,  570. 
compress,  cold,  571. 
definition,  570. 
pathology,  570. 
water  drinking,  571. 
Milium,  565,  566. 
causes,  566. 
definition,  566. 
pathology,  566. 
treatment,  566. 
Mimic  tic,  405.     Sec  spasm,  facial. 
Mineral  baths,  179. 

waters,  59. 
Minor  hydrothcrapeutic  methods,  85. 
Mitchell,  S.  Weir,  371. 
Mitral  regurgitation,  326. 

stenosis,  326. 
Montana  spotted  fever,  231. 
Monomania,  425. 
Morphine,  435. 

action  upon  nervous  system,  430. 
bodily  functions,  438. 
habit,  435. 

action  of,  436. 

administration,  site  of,  in,  440. 
bath,  horizontal  rain,  443. 

incandescent  electric  light,  443. 
neutral.  157. 
causes,  436. 

classes  afflicted  with,  438. 
classification  of,  439. 
consumption  of  drug  in,  440. 
convalescence,   treatment   of,  44o. 
cramps,     localized,     treatment     of, 

447. 
diarrhea,    treatment   of,    444. 


630 


IXDEX. 


Morphine  habit,  douche,  fan,  in.  443. 
formation  of  the,  439. 
indescribable  sensations,  treatment 

of,  444. 
insomnia,  treatment  of,  444. 
medical  prescription  as  cause,  439. 
nervousness,  treatment  of,  444. 
occupation,  effect  upon,  439. 
pack,  full  wet,  444. 
pains,  localized,  treatment  of,  444. 
pathology  of,  440. 
physician,  psychic  effect  of,  442. 
reaction,   hydrotherapeutic   in,  443. 
restlessness,  treatment  of,  444. 
sheet,  dripping,  444. 
spinal  pain,  treatment  of,  444. 
starting  of,  439. 

superheated  dry  hot  air  in,  443. 
-ymptoms  of  withdrawal  in,  441. 
toxemia  of,  441. 
treatment  of,  442. 
treatment,  psychic,  of,  442. 

states  of,  443. 
use,  method  of,  in,  440. 
vomiting,  treatment  of.  444. 
water  drinking  in,  60. 
Morris,  Geo.  W.,  275. 
Mosso,  138. 
Motor   restlessness   in   insanity,   confu- 

sional,  treatment,  424. 
Mueller,  136. 
Multiple  sclerosis,  353.  360.  See  ataxia, 

locomotor. 
Mumps,  219. 
bath,  sponge,   cold,  219. 
cause,  219. 
complications,  219. 
compress,  cold,  219. 
convalescence,  treatment,  220. 
definition,  219. 
fomentation,  219. 
prognosis,  219. 
treatment,  219. 
water  drinking,  219. 
Musa,  Antonius,  3. 

Muscles,    physiological    action    of    heat 
upon,  45. 
cold  upon,  46. 
hydrotherapy  upon,  44. 
Muscular  spasm,  fomentation  in,  122. 
system,    action    bath,    hot    air,    upon, 
77. 
hot  full,  upon,  151. 
Russian,   upon,   77. 
sitz,  cold,  upon.  144. 

hot,  upon,  146. 
Turkish,  upon.  77. 
vapor,  upon.   77. 

physiological,   of   cold   upon,   46. 
of  heat  upon,  45.  , 

of  hydrotherapy  upon,  44. 
pack,  full  wet  upon,  138. 
superheated  dry  hot  air  upon,  77. 
Myalgia,  bath,  hot  foot  in,   141. 

incandescent  electric   light  in,   174. 
Myelitis,   acute,   347. 

bag,  Chapman's  spinal  ice,  349. 
bath,  continuous,  159.  349. 


Myelitis,  acute,  causes,  348. 
compress,  trunk,  349. 
contraindications    of    fomentation, 

123. 
definition.  348. 
diet,  348. 
fomentation,  349. 
hygiene,  349. 

superheated  dry  hot  air,  84. 
treatment,   349. 
water  drinking,   3-19. 
chronic,  350. 
affusion,  351. 
bath,  continuous,  351. 
half,  148,  351. 
horizontal   rain,  352. 
incandescent   electric   light,  352. 
Xauheim,  351. 
causes,  350. 
definition,  350. 
diet,  351. 
douche,  fan,  352. 
fomentation,  352. 
hygiene.  351. 
pack,  half,  352. 
treatment,   351. 
Myocarditis,  317. 
bag,  ice,  in,  126. 
chronic,  326. 
Myositis,   293.     See   rheumatism,   mus- 
cular, 
bath,    incandescent    electric   light    in, 
74. 
sponge,  alternate  hot  and  cold.  118. 
douches  in,  192. 

Xakagami,  Dr.,  6.    , 
Xaso-pharynx,   diseases   of,   253. 
Xaumann,  29,  43. 

Xauheim  bath.     See  bath,   Xauheim. 
Xaupathia,  399.     See  seasickness. 
Xeedle  bath.  See  bath,  horizontal  rain. 
Nelson,  W.,  225. 
Xephritis.  acute,  307. 

baa:,  ice,  308. 

bath,  hot  full,  153,  308. 

causes,  307. 

cerebral   symptoms,   treatment.  308. 

definition,  307. 

diet,  307. 

enema,  307. 

fomentation,  307. 

hyeiene,  307. 

pack,  full  dry,  308. 

superheated  dry  hot  air,  308. 

treatment,  307. 

water  drinking,  307. 
acute  parenchymatous,  307. 
chronic,  308. 

bag.  ice,  310. 

bath,  horizontal  rain,  310. 

incandescent  electric   light,  310. 
Xauheim,  310. 
Turkish,  310. 

causes,  308. 

definition,  30S. 

diet,  309. 

hygiene.    309. 


INDEX. 


631 


Nephritis,  chronic,  pack,  full  wet,  309. 
sheet,  dripping,  310. 

superheated   dry  hot  air,  310. 
treatment,  209. 
water  drinking,  309. 
chronic,   interstitial,   303. 

parenchymatous,  308. 
Nephroptosis.       See     splanchnoptosis, 

311. 
Neptune's  girdle,   133. 
apparatus,  133. 
in  insomnia,  396. 
in   seasickness,    400. 
in  vertigo,  399. 
technique,   133. 
temperature  of,   133. 
Nerves,  peripheral,  diseases  of,  336. 
Nervous    diseases,    pack,    full    wet,    in, 
138. 
functional,  361. 
bath,  half,  in,  149. 
neutral,  in,  157. 

sponge,   alternate   hot   and   cold, 
118. 
douches  in,  192. 
pack,  full  wet,  in,  138. 
sheet,  dripping,   120. 
superheated  dry  hot  air,  84. 
system,  action  bath,  cold  full,  upon, 
171. 
hot  full,  upon,  151. 
warm  full  upon,  153. 
hot  air,  upon,  77. 
incandescent    electric    light,    upon, 

70. 
Xauheim,  upon,  164. 
neutral,  upon,  156. 
Russian,  upon,  77. 
sitz,  cold,  upon,  143. 

hot,  upon,  146. 
Turkish,  upon,  77. 
vapor,  upon,  77. 
Chapman's  hot  water  bag  upon,  87. 

ice  bags  upon,  87. 
douches,  cold,  upon,  190. 

hot,  upon,  189. 
morphine  upon,  436. 
pack,  full  wet,  upon,  137. 
physiological    action    hydrotherapy 
upon,  39. 
of  cold  upon,  43. 
of  heat  upon,  41. 
of  sunlight  upon,  64. 
superheated  dry  hot  air  upon,  77. 
Nettlerash,  555. 
Neuralgia,  340. 

bath,  hot  air,  342. 
hot  foot,  141. 
horizontal  rain,  342. 
incandescent     electric    light,    74, 
342. 
causes,  340. 

Chapman's  ice  bag  in,  87. 
definition,  340. 
diet,  341. 

douche,  Scottish,  342. 
douches  in.   192. 
fomentation,   341. 


xlii 


Neuralgia,  hygiene,  341. 
pack,  half.  342. 
rub,  salt,  90. 
sheet,  dripping,  342. 
superheated  dry  hot  air,  84,  341. 
treatment,  341. 
water  drinking,  342. 
intercostal,  340. 
bath,    sponge,    alternate    hot    and 
cold,  in,   118. 
ovarian,  bath,  hot  sitz,  in,  147. 

fomentation  in,  122. 
sciatic,  337. 

sexual.     See  neuroses,  sexual, 
spinal,  74. 
Xeurasthenia,  361. 
affusion,  366. 
anorexia,   treatment,  366. 
arc  light  in,  74. 
bath,  half,  149,  366. 

sponge,   alternate   hot   and   cold, 

to  spine,  118. 
cold,  365. 

horizontal  rain,  366. 
incandescent    electric    light,     74, 

366. 
warm  full,  366. 
neutral.   158. 
causes,  361. 

Chapman's  ice  bag  in,  87. 
definition,  361. 
diet.  361. 
douche,  fan,  366. 
jet,  366. 
Scottish,  366. 
douches  in,   192. 

dyspepsia,  nervosa,  treatment,  366. 
eye  pains  of,  treatment,  366. 
headaches  of,  treatment,  366. 
head  pressure  of,  treatment,  366. 
hygiene,  363. 

insomnia  of,  treatment,  366. 
mental    depression    of,    treatment, 

366. 
muscse     volitantes,     treatment     of, 

366. 
ovarian     irritation,     treatment     of, 

366. 
pack,  full  dry,  365. 
full  wet,  138,  365. 
pathology,   362. 
prognosis,  362. 
prophylaxis  of,  367. 
rest  cure  in,  363. 
rub,  salt,  366. 
rules  about,  96. 
sheet,  dripping,   120,  365. 
spine  of,  treatment.  366. 
spinal  irritation,   treatment,   366. 
sunlight  in,  74. 
superheated  dry  hot  air,  84. 
treatment,  363. 

vaginal  discharges,  treatment,  366. 
sexual,  537. 
Neurasthenic  heart,  332,  333. 
Neuritis,  acute,  336. 

bath,  horizontal  rain,  336. 
incandescent  electric  light,  74.  336. 


632 


INDEX. 


Neuritis,  acute,  bath,  neutral,  158. 
causes,  336. 
contraindications    of    fomentation, 

123. 
definition,  336. 
diet,  336. 
douches  in,  192. 
fomentation,  336. 
hygiene,  336. 
pack,  full  wet,  336. 
superheated  dry  hot  air,  84,  336. 
treatment,  336. 
chronic,   treatment  of,   337. 
multiple,  339. 
bag,  ice,  340. 
bath,  hot  full,  340. 
horizontal  rain,  340. 
incandescent  electric  light,  340. 
causes,  339. 
compress,  hot,  340. 
definition,  339. 
diet,  339. 
fomentation,  340. 
hygiene,  339. 
pack,  full  dry,  340. 

full  wet,  340. 
treatment,  339. 
sciatic,  337. 
anatomy,  337. 
bath,  horizontal  rain,  338. 
bath,  mineral,  339. 
sponge,  cold,  339. 
causes,  337. 
definition,  337. 
diet,  338. 

douche,  Scottish,  339. 
douches  in,  192. 
fomentation,  338. 
hygiene,  338. 
pack,  full  dry,  338. 
superheated  dry  hot  air,  338. 
treatment,  338. 
water  drinking,  338. 
Neuroses,  cardiac,  332. 
gastric,  motor,  250. 

of    intestines,   249.      See    intestinal 

neuroses, 
of  stomach,  249.     See  gastric  neu- 
roses. 
Neurosis,  fatigue,  400. 
occupation,  400. 
affusion,  402. 
bath,  hot  air,  402. 
horizontal  rain,  402. 
warm  full,  402. 
half,  402. 

incandescent    electric    light,    402. 
sponge,  cold,  402. 
vapor,  402. 
causes,  400. 
definition,  400. 
pack,  full  dry,  402. 

full  wet,  402. 
pathology,  401. 
rub,  salt,  402. 
sheet,  dripping,  402. 
symptoms,  401. 
treatment,  402. 


Neurosis,  professional,  400. 
sexual,  542. 

bath,  horizontal  rain,  543. 
incandescent  electric  light,  543. 
cold  sitz,  543. 
causes,  542. 
definition,  542. 
douche,  jet,  543. 
hvp-iene,  543. 
treatment,  543. 
Neutral  bath,   156.     Sec  bath,  neutral. 
North  American  Indians,  Russian  bath, 

74. 
Nose  bleed,  bath,  local  cold,  in,  142. 
Nurse  in  bath  room,  112. 

Obesity,  280,  302. 
bath,  half,  304. 
hot  air,  304. 

incandescent  electric  light,  304. 
Nauheim,  305. 
Turkish,  84. 
vapor,  304. 
causes,  303. 
definition,  302. 
diet,  303. 
douche,  fan,  304. 

jet,  304. 
hygiene,  303. 
pack,  full  wet,  304. 
superheated  dry  hot  air,  304. 
swimming,  304. 
treatment,  304. 
Occupation  neuroses,  400. 
Ochsner,  A.  J.,  595. 
Ochsner's  method  in  appendicitis,  595. 
Oertel,  O.,  303,  304,  324. 
Oil  rub,  90. 

physiological  action,  91. 
technique,  90. 
therapeutics,  91. 
use  by  swimmers,  91. 
Onanism,  538. 
Open  air  gymnasium,  66. 
Oophoritis,  acute,  525. 
bag,  ice,  525. 
bath,  sponge,  cold,  525. 
causes,  525. 
definition,  525. 
diet,  525. 

douche,  vaginal,  525. 
enema,  525. 
fomentation,  525. 
hygiene,  525. 
pathology,  525. 
symptoms,  525. 
treatment,  525. 
water  drinking,  525. 
chronic,  526. 

bath,  hot  full,  526. 
horizontal  rain,  526. 
incandescent  electric  light,  527. 
neutral,  527. 
cold  sitz,  526. 
sponge,  cold,  526. 
Turkish,  526. 
causes,  526. 
compress,  trunk,  527. 


INDEX. 


633 


Oophoritis,  chronic,  definition,  526. 
diet,  526. 

douche,  jet,  527. 

vaginal,  526. 
hygiene,  526. 
pack,  half  wet,  527. 

pelvic,  527. 
pathology,  526. 
sheet,  dripping,  526. 
superheated  dry  hot  air,  526. 
symptoms,  526. 
treatment,  526. 
Orchitis,  535. 
hag,  ice,  535. 
bath,  horizontal  rain,  535. 

incandescent  electric  light,  535. 
hot  sitz,  535. 
causes,  535. 
compress,  cold  and  cooling,  126. 

stimulating,  535. 
definition,  535. 
diet,  535. 
douche,  jet,  535. 
fomentation,  535. 
sequelae,  535. 
sheet,  dripping,  535. 
symptoms,  535. 
treatment,  535. 
Organic  diseases,  baths  in,  97. 
bath,  half,  in,  148. 
compress,  hot  in,  130. 
Osier,  Wm.,  202. 
Osteitis,  595.     See  periostitis. 
Osteoperiostitis,   595.     See  periostitis. 
Osteomyelitis,  595.     See  periostitis. 
Otitis  media,  acute,  579. 
Oxygen  bath,  166.     See  bath,  oxygen. 

Pachymeningitis,   cerebral,   342.     See 
meningitis, 
spinal,  342.     See  meningitis. 
Pack,  abdominal,  133. 
in  ulcer,  gastric,  240. 
hot  blanket,  139. 
apparatus,  139. 
in  alcoholism,  chronic,  494. 
in  emphysema,  269. 
technique,  139. 
temperature,  139. 
wet  blanket,  in  delirium,  acute  alco- 
holic, 485. 
chest,  132. 
full  dry,  139. 
apparatus,  140. 
contraindications,  140. 
in  alcoholic      intoxication,      acute, 

479. 
in  anemia,  313. 
in  arterio-sclerosis,  330. 
in  atony,  gastric,  235. 

intestinal,  235. 
in  bronchitis,  acute,  257. 

chronic,  259. 
in  diabetes  mellitus,  301. 
in  dilatation,  gastric,  235. 
in  eclampsia,   522. 
in  edema,  pulmonary,  261. 
in  endometritis,  acute,  516. 


Pack,  full  dry,  in  endometritis,  chronic, 
317. 

in  fever,  scarlet,  217. 

in  gastrointestinal   neuroses,  251. 

in  grippe,  211. 

in  heart   diseases,   functional,  334. 

in  hyperemia,    renal,   306. 

in  hysteria,  372. 

in  malaria,  212. 

in  migraine,  390. 

in  nephritis,  acute,  307. 
chronic,  310. 

in  neurasthenia,  365. 

in  neuritis,    multiple,   340. 
sciatic,  338. 

in  neurosis,  occupation,  402. 

in  paralysis  agitans,  404. 

in  rhinitis,  acute,  253. 

in  sciatica,  140. 

in  seasickness,  400. 

in  tuberculosis,  273. 

in  uremia,   311. 

in  urine,  suppression  of,  547. 

in  vertigo,  397. 

physiological  action,   140. 

technique,  140. 
half  dry,  141.  ^ 

in  congestion,  pulmonary,  260. 

therapeutics,  141. 
hot  dry,  in  dysentery,  acute,  145. 
half,  in  measles,  214. 

in  myelitis,  chronic,  352. 

in  neuralgia,  342. 

in  hemorrhage,  cerebral,  347. 
hot  half,  in  gastritis,  acute,  233. 
pelvic,  133. 

apparatus,  133. 

in  amenorrhea,  511. 

in  cellulitis,  pelvic,  chronic,  528. 

in  dysmenorrhea,  515. 

in  endometritis,  acute,  516. 
chronic,   518. 

in  hemorrhage,  uterine,  521. 

in  oophoritis,  chronic,  527. 

in  salpingitis,  chronic,  524. 

technique,  133. 

temperature  of,  133. 
salt,  in  synovitis,  chronic,  590. 
trunk,  in  endometritis,  acute,  516. 

in  feet,  cold,  574. 

in  prostatitis,  chronic,  537. 
half  wet,  139. 

apparatus,  139.  \ 

in  amenorrhea,  511. 

in  cellulitis,  pelvic,  chronic,  528. 

in  congestion,  pulmonary,  260. 

in  hemorrhage,  uterine,  521. 

in  oophoritis,  chronic,  527. 

in  salpingitis,  chronic,  524. 

physiological  action,  139. 

technique,  139. 

temperature,   139. 
half  wet,  in  surgery,  abdominal,  588. 
full  wet,  134. 

action  upon  blood,  138. 
circulation,  136. 
metabolism,  137. 
muscular  system,  138. 


634 


INDEX. 


Pack,    full    wet,    action    upon    nervous 
system,  137. 
respiration,  136. 
temperature,  136. 
apparatus,  134. 
contraindications,   139. 
in  alcoholism,  138. 
in  alcoholic      intoxication,      acute, 

479. 
in  anemia,  313. 
in  anidrosis,  570. 
in  ascites,  282. 
in  bronchitis,  acute,  257. 
in  chorea,  380. 
in  chronic   diseases,    138. 
in  delirium,    acute    alcoholic,   486. 
in  drug  habits,  138. 
in  dysentery,  acute,  245. 
in  enteritis,  acute,  243. 
in  erysipelas,  220. 
in  fevers,  138. 
in  fever,  typhus,  230. 
in  grippe,  211. 
in  hysteria,  373. 
in  insanity,   confusional,   424. 
in  insolation,  413. 
in  insomnia,  138,  395. 
in  lithemia,  299. 
in  malaria,  212. 
in  mania,  417. 

acute  alcoholic,  488. 
in  melancholia,  420. 
in  migraine,  391. 
in  morphine  habit,  444. 
in  nervous  diseases,  138. 

functional,  138. 
in  neurasthenia,  138,  365. 
in  neuritis,  acute,  336. 

multiple,  340. 
in  neuroses,  occupation,  402. 
in  obesity,  304. 
in  pericarditis,  316. 
in  pleuritis,  acute,  278. 
in  psychoses,  138. 
in  rhinitis,  acute,  253. 

chronic,  255. 
in  surgery,  abdominal,  588. 
in  ulcer,  gastric,  241. 
in  uterine  displacements,  519. 
in  vertigo,  398. 
physiological  action,   135. 
technique,  134. 
temperature  of,  135,  138. 
therapeutics  of,  138. 
pack,  hot  full,  139. 
in  enteritis,  acute,  243. 
in  rheumatism,  acute  articular,  290. 
Pain,    in    neuroses,    sexual,    treatment, 
543. 
pelvic.     See  congestion,  pelvic,  529. 
Palpitation,  cardiac,  332. 
Palsy,  facial,  336.    See  neuritis. 

shaking,  403. 
Panophthalmitis,   suppurative,  578. 
Paralysis,  cerebral,  84. 

contraindication     of     fomentation, 
123. 
spinal,  84. 


Paralysis  agitans,  403. 

bath,    incandescent    electric    light, 
404. 
horizontal  rain,  404. 
sponge,  cold,  404. 
causes,  403. 
definition,   403. 
diet,  404. 

pack,   full  dry,  404. 
pathology,  404. 
symptoms,  403. 
treatment,   404. 
bulbar,     acute,    347.       See    myelitis, 

acute, 
general,  of  insane,  431. 
Landry's,  347.     See  myelitis,  acute. 
Paranoia,  425. 
bath,  hot  air,  428. 
horizontal  rain,  428. 
incandescent  electric  light,  428. 
neutral,  428. 
causes,  425. 
childhood  of,  426. 
definition,  425. 
pathology,  427. 
prevention  of,  428. 
prognosis,  427. 
symptoms,  427. 
treatment,  427. 
Paraplegia,  ataxic,  352,  360.  See  ataxia, 

locomotor. 
Paresis,  general,  431. 
bath,  horizontal  rain,  434. 

incandescent    electric   light,   434. 
Turkish,  434. 
causes,  431. 
definition,   431. 
diagnosis,  432. 
diet,  433. 
douche,  jet,  434. 
hygiene,  433. 
pathology,  432. 
prognosis,  433. 
superheated  dry  hot  air,  434. 
symptoms,  432. 
treatment,  433. 
Parkinson's  disease,  403. 
Parorexia,  250. 
Pare,  Ambroise,  5. 
Parotitis.     See  mumps. 
Patent  medicine  habit,  474. 
Patrick,  H.  T.,  501. 
Pelvic  cellulitis,  527. 
congestion,  529. 

diseases,  bath,   Nauheim,  in,   165. 
inflammations,  compress,  hot,  in,  130. 
bath,  cold  sitz,  144. 
fomentation,  122. 
pack.     See  pack,  pelvic, 
pain,  529.     See  congestion,   pelvic, 
peritonitis,  527. 
Pemphigus,  557. 
bath,  continuous,  558. 
horizontal  rain,  558. 
incandescent  electric  light,  558. 
neutral,  558. 
causes,  557. 
definition,   557. 


INDEX. 


635 


Pemphigus,  pathology,  558. 

treatment,  558. 
Penzoldt,  248. 
Pericarditis,  316. 
bag,  ice,  316. 
compress,  cold,  316. 
causes,  316. 
definition,  316. 
diet,  316. 
hygiene,  316. 
pack,   full   wet,  316. 
treatment,  316. 
Perineal  douche.  See  douche,  perineal. 
Periostitis,  595. 
bath,  horizontal  rain,  595. 

sponge,  cold,  595. 
causes,  595. 
definition,  595. 
douche,  jet,  595. 
superheated  dry  hot  air,  595. 
symptoms,  595. 
treatment,  595. 
Peripheral  nerves,  diseases  of,  335. 
Peristaltic  unrest,  250. 
Peristyle,  3. 

Peritoneum,  diseases  of,  280. 
Peritonitis,  acute,  280. 
bag,  ice,  280. 
causes,  280. 

cardiac    weakness,    treatment,    280. 
compress,   stimulating,    128,   280. 
convalescence,  treatment,  281. 
definition,  280. 
diet,  280. 

fever,   treatment  of,  280. 
fomentation,  122,  280. 
hygiene,  280. 

tympanites,   treatment,  280. 
treatment,  280. 
vomiting,  treatment,  280. 
water  drinking,  281. 
chronic,  281. 

pelvic,  acute,  528.  See  cellulitis,  pel- 
vic, acute, 
pelvic,    chronic,    528.      See    cellulitis, 
pelvic,  chronic. 
Persians,  1. 

magi  of,  1. 
Pertussis,  215. 
bath,  horizontal  rain,  215. 

incandescent    electric    light,    215. 
neutral,  215. 
sponge,  cold,  215. 
cause,  215. 

cough,  treatment  of,  215. 
convalescence,   treatment   of,  215. 
definition,  215. 
hygiene,  215. 
sheet,  dripping,  215. 
treatment,  215. 
water  drinking,  215. 
Petronius,  4. 
Pettenkofer,  65. 
Pharyngitis,  254.     See  rhinitis,  acute. 

chronic,  254. 
Physical  properties  of  water,  12. 
Physiological  action  of  arc  light  bath, 
71. 


Physiological    action    of    alcohol    upon 
blood,  464. 

circulation,  462. 

heart,  462. 

kidney,  466. 

liver,  462. 

lungs,  466. 

metabolism,  467. 

mouth  and  gums,  460. 

mucous  membranes,  468. 

muscular  system,  465. 

nervous  system,  469. 

pulse,  463. 

sexual  system,  472. 

skin,  468. 

stomach,  461. 

temperature,  467. 
bath,  hot  air,  74. 

cold  foot,  142. 

hot  foot,  141. 

cold   full,   170. 

hot  full,  150. 

warm   full,   153. 

half,  148. 

incandescent  electric  light,  69. 

Nauheim,  163. 

neutral,    156. 

oxygen,  166. 

plunge,  cold,   175. 

Russian,  74. 

sand,  89. 

cold  sitz,  143. 

hot  sitz,  146. 

sponge,  cold,  117. 

surf,  177. 

Turkish,  74. 

vapor,  74. 
Chapman's  hot  water  bags,  87. 

ice  bags,  87. 
cold  upon  blood,  48. 

circulation,  28. 

muscular  system,  46. 

nervous  system,  43. 

respiration,  32. 

temperature,  25. 
compress,  cold  and  cooling,  124. 

hot,  129. 

stimulating,  127. 
douches,  cold,  189. 

hot,  188. 
friction,  88. 
fomentation,   122. 
heat  upon  blood,  48. 

circulation,   27. 

muscular  system,  45. 

nervous  system,  41. 

respiration,  32. 

temperature,  24. 
hydrotherapy  upon  absorption,  35. 

blood,  47. 

circulation,  26. 

excretion,  37. 

metabolism,  34. 

muscular  system,  44. 

nervous  system,  39. 

respiration,  31. 

secretion,  34. 

temperature,  23. 


636 


INDEX. 


Physiological    action    of    hydrotherapy 
upon  tissue  change,  36. 
water,  externally  applied,  21. 
internally,    155. 
hot,  58. 
local  cold,  85. 

dry  hot  air,  superheated,  78. 
hot  applications,  85. 
incandescent     electric     light     bath, 
70. 
pack,  full  dry,  140. 
half  wet,  139. 
full  wet,  135. 
rub,  oil,  91. 
sheet,  dripping,  120. 
superheated  dry  hot  air,  74. 
sunlight,  63. 
Physiology  of  skin,  11,  15. 
Pleurisy,  277.     See  pleuritis. 
Pleuritis,  acute,  277. 
bag,  ice,  278. 
bath,  half,  278. 
hot  air,  278. 
horizontal  rain,  279. 
incandescent   electric  light,  278. 
causes,  278. 

compress,   stimulating,  278. 
definition,  277. 
diet,  278. 
douches  in,   192. 
fomentation,  278. 
hygiene,  278. 
pack,  full  wet,  278. 
sheet,  dripping,  278. 
superheated  dry  hot  air,  84. 
treatment,   278. 
chronic,  279. 

douche,   fan,  279. 
Scottish,  279. 
Pleurodynia,  293. 
Plunge    bath,    cold.      See    bath,    cold 

plunge. 
Pneumonia,  catarrhal,  261.     See  pneu- 
monia, lobar, 
lobar,  261. 

bag,  ice,  126,  264. 
bath,  cold  full,  266. 
hot  full,  153,  265. 
sponge,  cold,  265. 
causes,  262. 
compress,  chest,  263. 

stimulating,  128. 
convalescence,   treatment  of,  266. 
cough,  treatment  of,  266. 
definition,  261. 
delirium,  treatment  of,  266. 
diet,  262. 
douches  in,  192. 
fomentation,  263. 
headache,   treatment,  266. 
hygiene,  262. 
insomnia,  treatment,  266. 
mortality,  262. 
superheated  dry  hot  air,  84. 
symptoms,   261. 
treatment,  265. 
treatment  in  alcoholics,  265. 
water  drinking,  262. 
Podagra,  295. 


Polioencephalitis,    superior,    347.      See 

myelitis,  acute. 
Poliomyelitis,  acute,  347.     See  myelitis, 
acute, 
chronic,  350.     See  myelitis,  chronic. 
Polyneuritis,  339. 
Polyphagia,  250. 
Pools,  swimming,  179. 
Popeschal,  202. 
Post-operative  inflammations,  253.  See 

rhinitis,   acute. 
Pott's  disease,  584. 
Pox,  543. 

Priessnitz,  Vincenz,  7,  8,  137. 
Pressure,    water,    in    hydrotherapeutic 

institutions,  108. 
Priapism,  542. 
bath,  half,  542. 

horizontal  rain,  542. 
incandescent  electric  light,  542. 
neutral  sitz,  542. 
causes,  542. 
definition,  542. 
diet,  542. 
douche,  jet,  542. 
treatment,  542. 
"Prickly  heat,"  570.  _ 
Primare  Verriicktheit,  425. 
Proctitis,  acute.     See  dysentery,  acute. 

chronic.      See   enteritis,    chronic. 
Prolapse  of  the  rectum,  553. 
Prostatitis,  acute,  535. 
bath,  cold  sitz,  144. 

hot  sitz,  536. 
causes,  536. 
definition,  535. 
diet,  536. 
fomentation,   536. 
hygiene,   536. 
symptoms,  535. 
treatment,  536. 
water  drinking,  536. 
chronic,  536. 
bag,  ice,  537. 
bath,  horizontal  rain,  537. 

incandescent  electric  light,  537. 
cold  sitz,  537. 
causes,  536. 
definition,  536. 
diet,  536. 

douche,  perineal,  537. 
enema,  537. 
hygiene,  536. 
pack,  trunk,  537. 
symptoms,  536. 
treatment,  536. 
Prostatorrhea,  bath,   cold   sitz,  in,   144. 
Pruritus,  573. 

bath,  Nauheim,  573. 
neutral,  158,  573. 
sponge,  alkaline,  118. 
causes,  573. 
definition,  573. 
douche,   fan,  573. 
treatment,  573. 

of  at  menopause,  532. 
water  drinking,  573. 
vulvae,  505. 
bath,  horizontal  rain,  505. 


INDEX. 


637 


Pruritus    vulvae,    incandescent    electric 
light,  506. 
hot  sitz,  506. 
neutral  sitz,  506. 
causes.  505. 
definition,  505. 
douche,  perineal,  506. 

vaginal,   506. 
fomentation,  506. 
treatment,  506. 
Psoriasis,  561. 
bath,  continuous,   561. 
horizontal    rain,    561. 
incandescent  electric  light,  561. 
neutral,  561. 
sponge,  cold,  561. 
causes,  561. 
definition,  561. 
douche,   fan,  561. 

Scottish,  561. 
pathology,  561. 
sheet,  dripping,  561. 
symptoms,  561. 
treatment,  561. 
Psychoses,  bath,  half,  in,  149. 
douches  in,   192. 
pack,  full  wet,  in,  138. 
exhaustion,  422. 
infection,   422. 
Korsakoff's,  422. 
toxic,  422. 
Pulmonic  regurgitation,  326. 

stenosis,   326. 
Pylorospasm,  250. 
Pyrexia,  of   infants,   154. 
bath,  warm  full,  in,  154. 

Quo  Vadis,  4. 

Rachitis,  280,  305. 
bath,  warm   full,  305. 

sponge,  cold,  305. 
causes,  305. 
definition.  305. 
rub,  oil,  305. 
treatment,  305. 
Reaction,  98. 
after  douches,  187. 
hydrotherapeutic,   49. 
imperfect,  9S. 

treatment  of,  98. 
in  morphine  habit,  443. 
Recovery    under    hydrotherapy,    102. 
Recti-procidentia,  553. 
Rectum,  diseases  of,  553. 
prolapse  of,  S53. 

bath,  horizontal  rain,  553. 

incandescent    electric    light,    553. 
causes,  553. 
definition,  553. 
douche,  perineal,  553. 
enema,  553. 
fomentation,   553. 
symptoms,   553. 
treatment,  553. 
ulcer  of.  552. 
Regurgitation,  350. 
aortic,  326. 


Regurgitation,  mitral,  326. 
pulmonic,  326. 
tricuspid,  326. 
Reichmann's    disease.    Sec    hypersecre- 
tion, states  of. 
Reiss,  159,  349,  350,  351. 
Remittent   fever.   See   fevers,   malarial. 
Renal  hyperemia,  306. 
Respiration,     action     bath,     cold     full, 
upon,  172. 
hot  full,  upon,   151. 
hot  air,  upon,  77. 
Nauheim,  upon,    163. 
Russian,  upon,  77. 
superheated  dry  hot  air,  77. 
Turkish,   upon,   77. 
vapor,  upon,  77. 
douches,  cold,  upon,  190. 

hot,  upon,  188. 
pack,  full  wet,  upon,  136. 
physiological,  of  heat,  32. 
of  hydrotherapy  upon.  31. 
of  cold  upon,  32. 
Rest    room    in    hydrotherapeutic    insti- 
tutions.  108. 
Retrostasis,  bath,  cold  sitz,  in.   143. 
compress,  cold  and  cooling  in,  126. 
prevention  of,   112. 
Rheumatism,  280. 

compress,   stimulating,    128. 
rub,  salt,  90. 
sunlight  in,  67. 
water  drinking  in,  60. 
acute  articular,  288. 
bag,  ice,  291. 
bath,     incandescent     electric    light, 

73,  289. 
causes,  288. 
cardiac     complications,     treatment, 

291. 
compress,   stimulating.  290. 
convalescence,  treatment,   291. 
definition,  288. 
diet,  289. 
hygiene,  289. 

hyperpyrexia,    treatment,    290. 
local  dry  hot  air,  superheated,  84. 
hydrotherapy,  as  a  preventive,  291. 
mortality,  288. 
pack,  hot  full,  290. 
superheated  dry  hot  air,  289. 
symptoms,  288. 
treatment,  288. 
chronic  articular,  291. 

bath,  contraindications  in,  293.. 
hot  full,  152,  291. 
incandescent   electric  light,   73. 
Nauheim,   165. 
mineral,   292. 
Russian,  292. 
Turkish,  292. 
causes,  291. 

compress,  stimulating,  292. 
definition,  291. 
diet,  292. 

douche,  Scottish,  293. 
douches  in,  192. 
fomentation,  292. 


638 


INDEX. 


Rheumatism,  chronic,  hygiene,  292. 
local  dry  hot  air,  superheated,  292. 
superheated  dry  hot  air,  292. 
treatment,  292. 
muscular,  293. 

bath,    incandescent    electric    light, 

293. 
causes,  293. 
definition,  293. 
douche,  Scottish,  293. 
fomentation,  293. 
treatment,  293. 
Rheumatoid     arthritis.      See     arthritis, 
rheumatoid. 
local    dry    hot    air,    superheated,    in, 
84. 
Rhinitis,  acute,  253. 
bath,  hot  full,  253. 
hot  foot,  253. 
horizontal  rain,  254. 
incandescent    electric    light,    254. 
shower,  253. 
sponge,  cold,  253. 
Turkish,  253. 
causes,  253. 
compress,  throat,  254. 
definition,  253. 
douche,   jet,  254. 
fomentation,  254. 
hygiene,  253. 
pack,   full  dry,  253. 

full  wet,  253. 
superheated  dry  hot  air,  254. 
treatment,  253. 
water  drinking,   253. 
chronic,  254. 
bath,  half,  255. 
hot  air,  255. 
hot  foot,  255. 
hot  full,  255. 
horizontal   rain,   255. 
incandescent    electric    light,    255. 
shower,   255. 
causes,  254. 
compress,  cold,  255. 

hot,  255. 
definition,   254. 
douche,  jet,  255. 
hygiene,  254. 
pack,  full  wet,  255. 
rub,  oil,  255. 

superheated  dry  hot  air,  255. 
surf  bathing,  255. 
treatment,  254. 
Richter,  581. 

Rickets,  305.     See  rachitis. 
Roehrig,   18. 

and  Zinlz,  37. 
Rub,  oil,   in   insanity,  confusional,  424. 
in  melancholia,  420. 
in  rachitis,  305. 
in  rhinitis,  chronic,  255. 
in  sprains,   582. 
salt,  89. 

in  ataxia,   locomotor,   354. 
in  atony,  gastric,  235. 

intestinal,  235. 
in  bladder,   atony  of.  550. 


Salt  rub  in  bronchitis,  chronic,  259. 

in  dilatation,    gastric,    235. 

in  endometritis,  acute,  517. 
chronic,  518. 

in  hypersecretion,    states   of,   239. 

in  hyposecretion,   states   of,   242. 

in  indigestion,  90. 

in  migraine,  391. 

in  neuralgia,  90. 

in  neurasthenia,    366. 

in  neuroses,   occupation,  402. 

in  rheumatism,  90. 

in  seasickness,  399. 

in  vertigo,  398. 

technique,  89. 
Rubeola.     See  measles. 
Rugel,  250. 
Rumination,  250. 
Russian  bath,  74,  81. 

"St.  Vitus'  dance,"  379.     See  chorea. 
Sadger,  240. 
Sajous,  E.  M.  de,  468. 
Salpingitis,  acute,  523. 
bag,  ice,  524. 
causes,  523. 
convalescence,  524. 
definition,  523. 
diet,  524. 

douche,  vaginal,  524. 
enema,  524. 
hygiene,  523. 
pathology,  523. 
sequelae,  523. 
symptoms,  523. 
treatment,   523. 
water  drinking,  524. 
subacute,  524. 
hygiene,  524. 
douche,  vaginal,  524. 
sequela?,  524. 
chronic,  524. 
bath,  hot  full,  524. 
horizontal  rain,  524. 
incandescent   electric   light,  524. 
shower,  cold,  524. 
compress,   stimulating,   524. 
enema,  524. 
douche,  vaginal,  524. 
hygiene,  524. 
pack,  half  wet,  524. 

pelvic,  524. 
sheet,  dripping,  524. 
superheated  dry  hot  air,  524. 
Salt  bag,  hot,  85. 

rub,  89. 
Sandals,  112. 
Sand  bag,  hot,  85. 
baths,  89. 

physiological   action,  89. 
technique,   89. 
Saundby,  309. 
Scale  in  bathroom,   112. 
Scarlatina.     See   fever,   scarlet. 
Scarlet   fever.     See   fever,   scarlet. 
Schleip,  Karl,  65. 
Schott,  A.,  162. 


INDEX. 


639 


Schott,   A.  and   T.     16 
_  Theodore,  318. 

Schueler,   Maximilian,  29,  30,  153. 
Sciatica,   337.     See   neuritis,   sciatic, 
Sclerosis,     amyotrophic,     lateral,     352. 
ataxia,    locomotor, 
disseminated,    352,    360.      See    ataxia, 

locomotor. 
lateral,   ?>bl.      Sec   ataxia,   locomotor, 
multiple,  ?>52.  360.     See  ataxia,  loco- 
motor. 
spinal,  spastic,  352,  359.     See  ataxia, 
locomotor. 
Scottish    douche.      See    douche,    Scot- 
tish. 
Scrofula,   superheated   dry   hot   air    in. 

84. 
Seasickness,   399. 
bag,  Chapman's  ice,  400. 
bath,  hot  full,  399. 
horizontal  rain,  399. 
incandescent   electric   light,   399. 
sponge,  cold,  399. 
causes,  399. 
definition,  399. 
douche,  jet,  400. 
enema,  399. 
fomentation,  400. 
Neptune's  girdle,  400. 
park,   full   dry,  400. 
rub,  salt,  399. 
symptoms,  399. 
treatment,   399. 
Sebaceous  glands,   17. 

of   skin,    14. 
Seborrhea,  572. 
bath,  horizontal  rain,  572. 

incandescent  electric  lieht,   572. 
causes,  572. 

compress,  stimulating,  573. 
definition,  572. 
douche,   fan,  572. 

jet.  572. 
hygiene,  572. 
symptoms,  572. 
treatment,  572. 
Secretion,   physiological    action    hydro- 
therapy upon,  34. 
Sedentary  and  hydrotherapy,   102,   103. 
douches  in,   192. 
sheet,  dripping,  in,  120. 
Seneca,  4. 
Sepsis,  593. 
Septic  infection,  593. 
Sexual    desire    at    menopause,    treat- 
ment, 532. 
excesses,  effects,  539. 
neuralgias,  542. 
neuroses,    542. 

weakness,  bath,  cold  sitz,  in,   144. 
irritable,  541. 
Shaking  palsy,  403. 
Shampoo,  88. 

in  alopecia,  567. 
Shattuck.  F.  C,  202. 
Sheet  bath.  118. 
Sheet,  dripping,  118. 
apparatus,  118. 


Sheet,    dripping,    contraindications,  120. 

how  to  vary,  119. 

in  abortion,  521. 

in  amenorrhea,  510. 

in  anemia,   120,  313. 

in  anidrosis,  570. 

in  asthma,  268. 

in  atony,  gastric,  235. 
intestinal,  235. 

in  bedridden   cases,    120. 

in  cardiac  disease,  organic,  327. 

in  chlorosis,   120. 

in  cholelithiasis,   286. 

in  cholera,   Asiatic,  229. 

in  chorea,  380. 

in  constipation,  248. 

in  diarrhea,   120. 

in  diabetes  mellitus,  301. 

in  dilatation,  gastric,  235. 

in  dystentery,   acute,    120,  245. 

in  emphysema,  269. 

in  endocarditis,    acute,    317. 
chronic,   516. 

in  enuresis,  551. 

in  enteritis,   chronic,   246. 

in  the  feeble,  120. 

in  insomnia,   120. 

in  gastritis,  chronic,  234. 

in  gastro-intestinal  neuroses,  251. 

in  goitre,  exophthalmic,  382. 

in  headache,   3S6. 

in  heart  diseases,  functional,  334. 

in  hypersecretion,  states  of,  239. 

in  hemorrhage,   uterine,   520. 

in  hysteria,   372. 

in  insanity,  con f visional,  424. 

in  jaundice,  catarrhal,  284. 

in  malaria,  212. 

in  melancholia,  420. 

in  menopause,  532. 

in  migraine,  390. 

in  morphine  habit,  444. 

in  nephritis,   chronic,  310. 

in  nervousness,    120. 

in  neurasthenia,   120,  365. 

in  neuralgia,  342. 

in  neurosis,  occupation,  402. 

in  oophoritis,  chronic,  526. 

in  orchitis.   535. 

in  pertussis,  215. 

in  pleuritis,  acute,  278. 

in  psoriasis,   561. 

in  salpingitis,   chronic,   524. 

in  sedentary,   120. 

in  spinal   curvature,   584. 

in  splanchnoptosis,   237. 

in  surgery,  abdominal,  588. 

in  uterine  displacements,  519. 

in  vertigo,   398. 

in  Weir   Mitchell  rest  cure,   120. 

physiological  action,  119. 

technique,  118. 

temperature  of,  119. 

therapeutics  of,   120. 
Shock,  surgical,  585. 

bag,  ice.  585. 

bath,  sponge,  cold,  586. 

causes,  585. 


640 


INDEX. 


Shock,  definition,  585. 
enema,  585. 
fomentation,   585. 
pathology,  585. 
superheated  dry  hot  air,  586. 
symptoms,  585. 
treatment,  585. 
Shower  bath.     See  bath,  shower. 
Sienkiewicz,  4. 
Siemens,  70. 
Sihler,  202. 

Simple  fevers,  196.  See  fevers,  simple. 
Skin,    11. 

anatomy  of,  13. 

action,   bath,    incandescent    electric 

light  upon,  69. 
as  excretory  organ,  16. 
as  a  heat  regulator,  18. 
as  a  protective  covering,  15. 
as  a  sensory  organ,  15. 
as  a  vascular  organ,  18. 
blood   supply  of,   14. 
nerve  supply  of,  14. 
physiology  of,   11,   15. 
diseases  of,  555. 
arc  light  in,  74. 
principles  of  treatment  in,  577. 
chronic,  555. 

hydrotherapy  in,  105. 
Slat  floor   in   hydrotherapeutic   institu- 
tions, 110. 
Sleep  normal,  392. 
causes  of,  392. 
physical  phenomena,  393. 
production  of,   392. 
sensations  of,  392. 
Smallpox.     See  variola. 
Snow,  Win.  Benham,  242. 
Soda  water,  drinking  of,  59. 
Solium,  4. 
"Sore   throat,   clergymen's,"   254.     See 

rhinitis,  chronic. 
Spasm,  facial,  406. 

bath,  horizontal  rain,  406. 

incandescent  electric  light,  406. 
causes,  406. 
definition,  405. 
douche,  jet,  406. 
fomentation,  406. 
superheated  dry  hot  air,  406. 
symptoms,  406. 
treatment,  406. 
habit,  405.     See  spasm,  facial. 
Spasmodic  tics,  405,  409.     See  spasm, 
facial, 
torticollis,  405,  407.     See  spasm,  fa- 
cial. 
Spasms,  hot  compress  in,  130. 
Special  therapeutics,   194. 
Spermatorrhea,  537. 
bath,  horizontal  rain,  539. 

incandescent  electric  light,  539. 
cold  sitz,  144,  540. 
neutral  sitz,  540. 
sponge,  cold,  539. 
causes,  537. 
definition.  537. 
douche,  fan,  540. 


Spermatorrhea,  douche,  jet,  540. 
perineal,  540. 
Scottish,  540. 
hygiene,  539. 
treatment,  539. 
varieties,  537. 
Sphincter  ani,  divulsion,  123. 
compress,  hot,  in,  131. 
fomentation  in,  123. 
Sphincterismus,  552. 
Spinal  caries,  584. 

bath,  sponge,  cold,  585. 
cause,  584. 
definition,   584. 
pathology,  585. 
curvature,  583. 
affusion,  584. 
bath,  half,  584. 

horizontal  rain,  584. 
incandescent  electric  light,  584. 
sponge,  cold,  584. 
causes,  583. 
definition,  583. 
douche,  fan,  584. 
jet,  584. 
Scottish,  584. 
sheet,  dripping,  584. 
treatment,  584. 
curvature,  angular,  584. 
cord,  diseases  of,  335. 
diseases,    chronic,    352.     See    ataxia, 
locomotor, 
organic,  bath,  half,  in,   148. 
irritation,  361. 
scleroses,  combined,  352.  See  ataxia, 

locomotor, 
sclerosis,     spastic,     352,     359.       See 
ataxia,   locomotor. 
Spitzka,  E.  C,  431. 
Splanchnoptosis,  237. 
bath,  hot  air,  237. 
horizontal   rain,   237. 
incandescent  electric  light,  237. 
causes,  237. 
definition,  237. 
diet,  237. 
douche,  fan,  237. 
jet,  237. 

cold  plantar,  237. 
hygiene.  237. 
sheet,  dripping,  237. 
symptoms,  237. 
treatment,  237. 
Spoliatorium,  3. 
Spondylitis,  584. 

Sponge  bath,  115.     See  bath,  sponge, 
hot  and  cold  spinal,  120. 
in  enuresis,  551. 
in  melancholia,  421. 
Sprains,  581. 
bath,  hot  foot,  141,  581. 

sponge,  alternate  hot  and  cold,  118. 
horizontal  rain,  582. 
definition,  581. 
douche,  Scottish,  582. 
fomentation,    123,   581. 
pathology,  581. 
superheated  dry  hot  air,  581. 


INDEX. 


641 


Sprains,  superheated  dry  hot  air,  local, 
84. 
symptoms,    581. 
treatment,    581. 
Spray  hath.   Sec  bath,  horizontal   rain. 
Stadium,  4. 
Steam,  92. 

administration  of,  93. 
therapeutics  of,  93. 
inhalations,  92. 

in  bronchitis,  acute,  257. 
in  laryngitis,  spasmodic,  256. 
in  rhinitis,  acute,  254. 
Stenosis,  aortic,  326. 
mitral,  326. 
pulmonic,  326. 
tricuspid,  326. 
Sterility,  529. 
bath,  horizontal  rain,  530. 

incandescent  electric  light,  530. 
cold  sitz,  530. 
causes,  529. 
definition,  529. 
douche,  jet,  530. 

vaginal,  530. 
hygiene,   530. 
treatment,  530. 
Sterne,  Albert  E.,  350. 
Stevenson  and  Jones,  92. 
Stomach,  diseases  of,  233.     See  gastric 
diseases, 
neuroses   of,  249.     See  gastric  neu- 
roses. 
Stove  lids,  hot,  85. 
Strasser,   A.,   28,   38,   48,   65,    148,    170, 

245,  270. 
Strieker,  154. 
Strigillus,  3. 

Strumpell,  Adolph,  202,  328. 
Sudamina,  570. 
bath,  neutral,  571. 

sponge,  cold,  571. 
causes,  570. 
compress,  cold,  571. 
definition,  570. 
diet,  571. 
pathology,  570. 
treatment,  571. 
water   drinking,  571. 
Sudatorium,  3. 
Sue,  Eugene,  227. 

Summer  complaint.  See  enteritis,  acute. 
Sunlight,  62. 
absence  of,  64. 

on   visual  organs,  65. 
action  upon  absorption,  65. 
assimilation,  65. 
bacteria,  63. 
blood,  65. 

nervous  system,  64. 
skin,  63. 
benefits  of,  64. 
in  anemia,  67. 
in  chlorosis,  67. 
in  diabetes,  67. 
in  dyspepsia,  chronic,  67. 
in  gout,  67. 
in  neurasthenia,  67. 


Sunlight,  benefits  of,  in  rheumatism,  67. 
physiological  action  of,  63. 
therapeutic  application  of,  67. 
Sunstroke,  410.     See   insolation. 
Superheated  dry  hot  air,  74,  82. 
action  upon  blood,  77. 

circulation.  77. 

digestion,  77. 

elimination,  78. 

metabolism,  77. 

muscular  fibre,  77. 

nervous  system,  77. 

respiration,  77. 

temperature,  78. 
apparatus,  82. 

body,  82. 

local,  82. 

contraindications,  84. 

in  acne,  560. 

in  anidrosis,   569. 

in  ankylosis,  591. 

in  arthritis,  rheumatoid,  294. 

in  ascites,  282. 

in  bronchitis,  acute,  257. 

in  carbuncle,  564. 

in  cellulitis,  pelvic,  chronic,   528. 

in  comedo,  566. 

in  cerebral  paralvsis,  84. 

in  diabetes,  84,  301. 

in  dyspepsia,   chronic,  84. 

in  enteritis,  84. 

in  epilepsy,  378. 

in  exudates,    128. 

in  fever,  surgical,  587. 

in  gangrene,  593. 

in  gout,  295. 

in  grippe,  210. 

in  herpes,  simplex,  558. 

in  hyperemia,  renal,  306. 

in  hysteria,   84. 

in  infection,  septic,  593. 

in  kidney  diseases,  84. 

in  locomotor  ataxia,  84. 

in  malaria,  213. 

in  metallic  poisoning.  84. 

in  morphine   habit,   443. 

in  myelitis,  84. 

in  nephritis,   acute,  308. 
chronic,   310. 

in  nervous  diseases,  functional,  84. 

in  neuralgia,  342. 

in  neurasthenia,  84. 

in  neuritis,  acute,  84,  336. 
sciatic,  338. 

in  obesity,  84,  304. 

in  oophoritis,  chronic,  526. 

in  paresis,  434. 

in  periostitis,  595. 

in  pleurisy,  84. 

in  pneumonia,  84. 

in  rheumatism,  acute  articular,  289. 
chronic  articular.  292. 

in  rhinitis,  act:te,  254. 
chronic,  255. 

salpingitis,  chronic,  524. 

scrofula,  84. 

in  shock,  surgical,  586. 

in  spasm,  facial,  406. 


642 


INDEX. 


Superheated  dry  hot  air,  contraindica- 
tions in  spinal  paralyses,  84. 
in  sprains,  581. 
in  surgery,  abdominal,  588. 
in  synovitis,  acute,  590. 

chronic,  590. 
in  syphilis,  84,  546. 
in  torticollis,  rheumatic,  408. 
in  ulcer,  592. 
in  uremia,  311. 
in  urine,  suppression  of,  547. 
in  vertigo,  398. 
physiological  action,  74. 
technique,  82. 
therapeutics  of,  83. 
Surf,  chemical  composition  of,  176. 
bathing,  176. 

contraindications,   178. 
evil  effects  of,   177. 
in  acne,   560. 
in  eczema,  560. 
in  enuresis,  551. 

in  gastro-intestinal    neuroses,    251. 
in  hyposecretion,    states   of,   243. 
in  rearing   of   delicate   child,   504. 
in  rhinitis,  chronic,  255. 
in  syphilis,  546. 
physiological  action,   177. 
temperature  of,   176. 
Surgery,  bath,  hot  foot,  in,  142. 
abdominal,  588. 
bag,   ice,  588. 
bath,  hot  air,  588. 
horizontal  rain,  588. 
incandescent  electric  light,   588. 
sponge,  cold,  588. 
compress,  trunk,  588. 
fomentation,  588. 
pack,  full  wet,  588. 

half  wet,  588. 
preparation  for,  588. 
sheet,  dripping,  588. 
superheated  dry  hot  air,  588. 
Surgery,  hydrotherapy  in,  580. 
Surgical  cases,  fomentation  in,  123. 
Surgical  shock,  585. 
Susrotas,  Vedas  of,  1. 
Sweating,  75. 
as  an  eliminant,  75. 
bath,  75. 
value  of,  76. 
Sweat  glands  of  skin,  14,  16. 
Swimming  bath,  176. 

in  diabetes  mellitus,  301. 
in  hyposecretion,  states  of,  243. 
in  obesity,  304. 
pools,  179. 
Synovitis,  acute,  589. 
bag,  ice,  590. 
causes,  589. 
compress,  hot,  in,  130. 

cooling,  590. 
definition,  589. 
pathology,  589. 
superheated  dry  hot  air,  590. 

local,  84. 
symptoms,  590. 
treatment,  590. 


Synovitis,  chronic,  590. 
causes,  590. 

compress,  stimulating,  590. 
definition,  590. 
douche,  Scottish,  591. 
"pack  salt,"  590. 
pathology,  590. 
superheated  dry  hot  air,  590. 
symptoms,  590. 
treatment,  590. 
Syphilis,  533,  543. 
affusion,  545. 
bath,  hot  air,  546. 

hot  full,  546. 

half,  545. 

horizontal  rain,  545. 

incandescent    electric    light,    74, 
545. 

sponge,  cold,  546. 

shower,  cold,  546. 

vapor,  546. 
cause,  543. 
definition,  543. 
diet,  545. 
douche,  fan,  545. 

jet,  545. 
hygiene,   545. 
hydrotherapy  in,  545. 
in  Sandwich  islanders,  545. 
pathology,  544. 

superheated  dry  hot  air   84,  546. 
surf  bathing,  546. 
symptoms,  544. 
treatment,  544. 
cachexia  of,  treatment,  546. 

Tachycardia,  332. 
causes,  333. 
treatment,  333. 
Tallerman-Schefneld,      local      hot      air 

bath,  82. 
Tanner,  Dr.  54. 
Technique.     See  separate  headings. 

of  hydrotherapy,  114. 
Temperature,     action,     bath,     hot     air, 
upon,  78. 
cold  full,  upon,  171. 
hot  full,  upon,  151. 
Nauheim,  upon,  163. 
Russian,  upon,  78. 
cold  sitz,  upon,   144. 
hot  sitz,  upon,  146. 
sponge,  upon,   116. 
Turkish,  upon,  78. 
vapor,  upon,  78. 
cerebral  coil  cap  upon,  85. 
douches,  cold,  upon,  189. 

hot,  upon,  188. 
pack,  full  wet,  upon,  136. 
physiological,  upon,  23. 
of  cold,  upon,  25. 
of  heat,  upon,  24. 
superheated  dry  hot  air,  78. 
water  drinking  upon,  56. 
classification  of,  22. 
decreased  bodily,  24. 
duration  of  bath  and,  99. 
of  bath,  cleansing,  155. 


INDEX. 


643 


Temperature  of   bath,   hot   foot,   141. 
cold  full,  168. 
warm  full,  153. 
hot    full,   ISO. 
half,  147. 
Nauhcim,  161. 
oxygen,  166. 
cold  plunge,  175. 
room,  99. 
cold  sitz,  143. 
hot  sitz,  146. 
compress,  cephalic,  131. 
chest,  132. 
joint,  134. 
throat,   132. 
trunk,  133. 
douches,  cold,  186. 
•     hot.  188. 

Scottish,  186. 
fomentation,  122. 
increased  bodily,  23. 
of  Neptune's  girdle,  133. 
of  pack,  blanket,  139. 
pelvic,   133. 
full  wet,  135. 
half  wet,   139. 
sheet,  dripping,  119. 
surf,  176. 
Tepidarium,  3. 
Thayer,  William,  48,  174. 
Therapeutics  of  bath,  continuous,   159. 
electric,  92. 
cold  full,  174. 
hot  full,  152. 
warm   full,   154. 
half,  148. 

incandescent  electric  light,  73. 
Nauheim,  165. 
neutral,  157. 
cold  sitz,  144. 
hot  sitz,  146. 
compress,  cephalic,  131. 
chest,  133. 

cold  and  cooling,  125. 
hot,  130. 
stimulating,  128. 
douche,  cold,  192. 

hot,  189. 
fomentation,  122. 
friction,  88. 
pack,  half  dry,   141. 

full  wet,  138. 
rub,  oil,  91. 
sheet,  dripping,  120. 
steam,  93. 
sunlight,  67. 

superheated  dry  hot  air,  83. 
water  drinking,  59. 
special,  194. 
Thermae  of  Caracalla,  3. 
Thermic  action  of  water,  12. 
fever,  410.     See  insolation. 
Throat  compress,   131.     See  compress, 
throat, 
inflammations,     compress,     cold     or 
cooling  in,  126. 
hot,  130. 
stimulating,  128. 


Thompson,  200. 
Tic  de  pensee,  409. 

douloureaux,   340.      See    neuralgia, 
mimic,  405.     See  spasm,  facial. 
Tics,  spasmodic,  405,  4C9.     Sec  spasm, 

facial. 
Tinnitus  aurii,  396.     See  vertigo. 

cerebri,  396.     See  vertigo. 
Tissue  change,  physiological  action  hy- 
drotherapy upon,  36. 
Tobacco  habit,  445. 
poisoning,  acute,  447. 
causes,  447. 
symptoms,  447. 
Todd,  J.  B.,  262. 

Tonsillitis,    acute,    252.      See    rhinitis, 
acute, 
compress,  hot,  in,  130. 
stimulating,  in,  128. 
chronic,  254.     See  rhinitis,  chronic. 
Toothache,  compress,  hot,  in,  130. 
Torticollis,  293. 
rheumatic,  408. 

bath,  horizontal   rain,  409. 
causes,  408. 
compress,  hot,  409. 
douche,  Scottish,  409. 
superheated  dry  hot  air,  408. 
treatment,  408. 
spasmodic,  405,  407.     See  spasm,  fa- 
cial, 
causes,  407. 
definition,  407. 
symptoms,  407. 
treatment,   408. 
Towel  bath,  115. 
Trades,  Alexander,  5. 
Traube,   171. 

Trauma,  pains  of,  bath,  alternate  hot 
and  cold  sponge,   118. 
compress,  hot  in,  130. 
Treatment,  duration  of,  96. 
Tricuspid   regurgitation,   326. 

stenosis,    326. 
Trinecek,  his  plasma,  330. 
Thrombosis,    cerebral,    344,    345.      See 

hemorrhage,   cerebral. 
Trunk  compress.  See  compress,  trunk. 
"Tubbing."     See  bath,  cold  full. 
Tuberculosis,  270. 

action   hydrotherapy  in. ^273,   276. 
bacilli,  destruction  of,  270. 
bag,   ice,   274. 
bath,   hot    full,   273. 
hot  air,   273. 
horizontal  rain,  274. 
incandescent   electric  light,  274. 
Nauheim,  275. 
shower,  273. 
causes,  270. 
climate  in,  275. 
compress,   chest,   273. 
cough,  treatment  of,  275. 
definition,  270. 
diet,  272. 
discipline  in,  276. 
dress,  272. 
douche,  jet,  274. 


644 


INDEX. 


Tuberculosis,  friction,  273. 

heredity,  271. 

hygiene,  271. 

night  sweats,  treatment,  275. 

pack,  full  dry,  273. 

pathology,  270. 

prophylaxis,  270. 

pyrexia,   treatment,  275. 

rest,  272. 

treatment,  ideal,  276. 
joint,  superheated  dry  hot  air  in,  84. 
Turban,  135. 

Turkish  bath,  74.     See  bath,  Turkish. 
Tuttle,  Jas.  P.,  247. 
Tympanites,  250. 

in  typhoid,  treatment,  208. 
Typhoid   fever.      See   fever,   typhoid. 
Typhus  fever.     See  fever,  typhus. 
Tyson,  202. 

Ulcer,  592. 

bath,  continuous,  593. 
horizontal  rain,  592. 
incandescent  electric  light,   592. 
causes,  592. 
definition,  592. 
douche,  Scottish,  593. 
pathology,  592. 
superheated  dry  hot  air,  592. 
symptoms,  592. 
treatment,  592. 
duodenal.     See  ulcer,  gastric, 
gastric,  239. 
bag,  ice,  241. 
bath,  half,  241. 
cold  sitz,  240. 
sponge,  cold,  241. 
causes,  240. 

compress,  hot  abdominal,  240. 
definition,  239. 
diet,  240. 
fomentation,  240. 
hygiene,  240. 
pack,  abdominal,  240. 

full  wet,  241. 
symptoms,  239. 
treatment,  240. 
Ulcers,  bath,  hot  foot,  in,  142. 

compress,  stimulating,  128. 
Unctuarium,  3. 
Uremia,  311. 
bag,  ice,  311. 
bath,  hot  air,  311. 
horizontal  rain,  311. 
sponge  cold,  311. 
causes,  311. 
definition,  311. 
enema,  311. 
fomentation,  311. 
pack,   full  dry,  311. 
superheated  dry  hot  air,  311. 
treatment,  311. 

water   drinking,   311. 
Uremic  poisoning,  311. 
Urethritis,  533.     See  gonorrhea. 
Uric  acid  diathesis,  bath,  incandescent 

electric  light  in,  73. 
Uricacidemia,  298.     See  lithemia. 


Uricacidemia,  treatment  of,  299. 

water  drinking  in,  60. 
Urine,  action  of  water  drinking  upon, 
57. 
incontinence,  bath,  cold  sitz,  in,   144. 
retention  of,  551. 

bath,  horizontal  rain,  552. 

incandescent  electric  light,   552. 
hot  sitz,  551. 
causes,  551. 
definition,  551. 
douche,  jet,  552. 
enema,  551. 
treatment,  551. 
suppression  of,  546. 
bag,  ice,  547. 

bath,     incandescent    electric    light, 
547. 
warm  full,  547. 
Nauheim,  547. 
neutral,  547. 
causes,  546. 
definition,  546. 
enema,  547. 
fomentation,  547. 
pack,  full  dry,  547. 
superheated  dry  hot  air,  547. 
symptoms,  546. 
treatment,  547. 
water  drinking,  547. 
Urticaria,  555. 
bath,  hot  full,  555. 
horizontal  rain,  555. 
incandescent  electric  light,  555. 
neutral,  555. 
sponge,  cold,  555. 
alkaline,   118. 
causes,  555. 
definition,  555. 
douche,  jet,  555. 
symptoms,  555. 
treatment,  555. 
Uterine  displacements,  519. 
bath,  horizontal  rain,  519. 

incandescent  electric  light,  519. 
cold  sitz,  519. 
pack,  full  wet,  519. 
sheet,  dripping,  519. 

Vaginal  douche,  94. 
Vaginitis,  507. 
bath,  horizontal  rain,  508. 

incandescent  electric  light,  508. 

cold  sitz,  508. 

hot  sitz,  508. 
causes,  507. 
definition,  507. 
douche,  vaginal,  508. 
treatment,  507. 
Vaginismus,  506. 
bath,  hot  air,  507. 

horizontal  rain,  507. 

incandescent  electric  light,  507. 

hot  sitz,  147,  507. 
causes,  506. 
definition,  506. 
douche,  jet,  507. 

perineal,  507. 


INDEX. 


645 


Vaginismus,  treatment,  507. 
Valvular  heart   diseases,  organic,  326. 
Vapor  hath,  74. 

action   upon  blood,  77. 

circulation,  76. 

digestion,  77. 

elimination,  78. 

metabolism,  77. 

muscular  fibre,  77. 

nervous  system,  77. 

respiration,  77. 

temperature,  78. 

physiological,   74. 
Varicella,  214. 
bath,  neutral,  215. 
causes,  214. 
definition,  214. 
mortality,  214. 
treatment,  214. 
Variola,  222. 

bath,  continuous,  223. 

cold  full,  224. 

hot  full,  223. 

neutral,  223. 
causes,  222. 

compress,  abdominal,  223. 
constipation,  treatment,  224. 
convalescence,  treatment,  224. 
definition,  222. 

delayed  eruption,  treatment,  224. 
delirium,  treatment,  224. 
diarrhea,  treatment,  224. 
diet,  223. 
hygiene,  223. 

insomnia,  treatment,  224. 
laryngitis,  treatment,  224. 
mortality,  223. 
nausea,  treatment,  224. 
pathology,  222. 
symptoms,  222. 
treatment,  223. 
vomiting,  treatment,  224. 
water  drinking,  224. 
Varochilisky,  343. 
Vascular    disease,    bath,    Nauheim,    in, 

165. 
Vedas  of  Susrotas,  1. 
Vertigo,  397. 
affusion,  398. 
bag,  ice,  397. 
bath,  warm  full,  398. 

half,  398. 

horizontal  rain,  398. 

incandescent  electric  light,  398. 

Nauheim,  397. 

shower,  cold,  398. 

sponge,  cold,  398. 
causes,  397. 
definition,  397. 
douche,   fan,  398. 

jet,  398. 
lavage,  397. 
Neptune's  girdle,  399. 
pack,  full  dry,  397. 

full  wet,  398. 
prognosis,  397. 
rub,  salt,  398. 
sheet,  dripping,  398. 


Vertigo,  superheated  dry  hot  air,  398. 

treatment,  397. 
Vesical  irrigation,  94. 

catarrh,  bath,  hut  sitz,  in,  144. 

paralysis,  hath,  cold  sitz,  in,   144. 
Vesiculitis,  seminal,  hath,  cold  sitz,  in, 

144. 
Vinag  and  Maggiora,  46. 
Vogel,  202. 
Vogt,  459. 
Voigt,  65. 

Vomiting,    after    operation,    treatment, 
589. 

bag,  ice  in,  126. 

ice,  Chapman's,  in,  87. 

cyclic,  in  children,  250. 

in     alcoholism,     chronic,     treatment, 
493. 

nervous,  250. 
Vulvae,  pruritus,  505. 
Vulval   inflammations,    fomentation   in, 

122. 
Vulvitis,  505. 

bath,  hot  sitz,  505. 

causes,  505. 

definition,  505. 

douche,   vaginal,   505. 

treatment,  505. 
Vulvo  vaginal  hyperesthesia,  506. 

Warm  full  hath.     See  hath,  warm  full. 
Water,  abstinence   from,  55. 
adaptability,  12. 
cleansing    action    of,    12. 
incernal  uses,  54. 
mechanical  action  internally,  55. 

effects,  12. 
physiological  action,  externally,  21. 

internally,   55. 
physical  properties  of,  12. 
thermic  action,  12. 
drinking,  action  upon  blood,  56. 
circulation,  56. 
digestion,  57. 
excretion,  56. 
metabolism,  57. 
temperature,  56. 
urine,  57. 
amount  of,  58. 
before  operations,  589. 
carbonated,  59. 
contraindications,   cold,   61. 
hot,  in  colic,  61. 

in  gastralgia,   61. 

in  gastritis,  61. 

in  hyperpepsia,  61. 
in  alcoholism,  60. 
in  ascites,  60,  281. 
in  anemia,    pernicious,    315. 
in  bladder,  atony  of,   549. 
in  bronchitis,  acute,  257. 

chronic,  259. 
in  cardiac  collapse,  334. 
in  cholelithiasis,  285. 
in  cirrhosis,  hepatic,  286. 
in  coffee  habit,  454. 
in  colic,  renal,  312. 
in  constipation,  247. 


646 


INDEX. 


Water  drinking  in  cystitis,  548. 

in  delirium,    acute    alcoholic,   484. 

in  diphtheria,   218. 

in  dysmenorrhea,   515. 

in  eczema,  557. 

in  enteritis,  acute,  243. 

in  epididymitis,  534. 

in  erysipelas,  220. 

in  exudates,  60. 

in  fever,  scarlet,  216. 

surgical,  587. 

yellow,  226. 
in  fevers,  60. 
in  gastritis,   acute,  233. 

chronic,  234. 
in  gastro-intestinal  neuroses,  251. 
in  gout,  60. 
in  gall-stones,  60. 
in  hemorrhage,  587. 

cerebral,  346. 
in  hepatic  diseases,  60. 
in  hyperemia,   renal,  306. 
in  hypersecretion,    states    of,   238. 
in  jaundice,    catarrhal,   284. 
in  malaria,  212,  213. 
in  measles,  214. 
in  migraine,  392. 
in  miliaria,  571. 
in  morphinism,   60. 
in  mumps,  219. 
in  myelitis,  acute,  349. 
in  nephritis,  acute,  307. 

chronic,  309. 
in  neuralgia,  342. 
in  neuritis,  sciatic,  338. 
in  oophoritis,  acute,  525. 
in  peritonitis,  acute,  281. 
in  pertussis,  215. 
in  pneumonia,  262. 
in  prostatitis,  acute,  536. 
in  pruritus,  573. 
in  rheumatism,  60. 
in  rhinitis,   acute,   253. 


Water    drinking    in    salpingitis,    acute, 
524. 
in  sudamina,  571. 
in  tobacco  habit,  453. 
in  typhoid,  60. 
in  uremia,  311. 
in  uricacidemia,    60. 
in  variola,  224. 
in  urine,  suppression  of,  547. 
soda  water,  59. 
therapeutics  of,  59. 
time  of,  58. 

pressure    in    hydrotherapeutic    insti- 
tutions, 108. 
supply,   hot,   in   hydrotherapeutic   in- 
stitutions, 108. 
for    hydrotherapeutic    institutions, 
107. 
Watson,  Sir  Thomas,  227. 
Welch,  W.  H„  202. 
Wet  pack.     See  pack,  wet. 
Whooping  cough.     See  pertussis. 
Wilson,  202. 

Winternitz,  Wm.,  2,  5,  9,  26,  28,  30,  36, 
47,  48,  56,  60,  88,  89,  114,  127, 
145,  166,  174,  202,  229,  245,  246, 
248,  275,  306,  521,  534. 
Wollisch,  154. 
Women,   hydrotherapy   for,   103. 

diseases  of,  505. 
Woodhead,  Sims,  464,  468. 
Wounds,    compress,    cold   and   cooling, 

in,  126. 
Wolf,  Eugene,  400. 
Writer's  cramp,  400. 
Wry  neck,  293,  405,  407.     See  spasm, 
facial. 

"Yellow  Jack."     See   fever,  yellow. 
Yeman,  H.  W,  400. 

ZlEMSSEN,    202. 

graduated  bath,  169. 


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